CMS/EIP Fiscal Report Center: 09
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 142 205.250000 7594.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 90 51.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 167 496.750000 18379.7500 37.0000
Subtotal (Total Children Is Unduplicated) 179 753.000000 25974.0000 34.4940
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 86 122.500000 9037.0000 73.7714
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 50.500000 3619.1800 71.6669
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 60.000000 4462.5000 74.3750
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 80 122.500000 6771.0000 55.2735
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 94.000000 7050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 160 460.500000 31657.4300 68.7458
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EI Services,Class #03
INTR-T1013-INTERPRETER 13 19.250000 962.5000 50.0000
Subtotal (Total Children Is Unduplicated) 13 19.250000 962.5000 50.0000
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Total 1232.750000 58593.9300 47.5311
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Number of Children (Unduplicated) With at Least One Service 184
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Center 09
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 28 40.750000 2588.2500 0.0000
P 928 1135.000000 51768.1800 51805.6800
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 1 2.000000 112.5000 37.5000
41 55.000000 4125.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 998 1232.750000 58593.9300 51843.1800