CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 56 90.000000 3330.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 21.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 154.500000 5716.5000 37.0000
Subtotal (Total Children Is Unduplicated) 56 265.500000 9046.5000 34.0734
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 14.500000 1087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 32.500000 1803.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
Subtotal (Total Children Is Unduplicated) 39 92.000000 6246.7500 67.8995
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 3 6.000000 351.0000 58.5000
Subtotal (Total Children Is Unduplicated) 3 6.000000 351.0000 58.5000
-----------------------------------------------------------------------------------------------------------------------
Total 363.500000 15644.2500 43.0378
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 56
-----------------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 3 6.000000 351.0000 351.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
522 357.500000 15293.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 525 363.500000 15644.2500 351.0000