CMS/EIP Fiscal Report Center: 52
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 40 19.000000 703.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 48 74.000000 64.7500 0.8750
TCM-T1017TL-TARGETED CASE MANAGEMENT 85 315.000000 11645.7500 36.9706
Subtotal (Total Children Is Unduplicated) 85 408.000000 12413.5000 30.4252
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 88.000000 6450.0000 73.2955
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 26.000000 1950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 62 114.500000 6222.7500 54.3472
Subtotal (Total Children Is Unduplicated) 67 242.500000 15672.7500 64.6299
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EI Services,Class #03
CONIF-CONIF-CONSULT, FACE TO FACE 1 0.750000 37.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14 25.000000 250.0000 10.0000
TRAV-TRAVS-Travel by mile 42 1151.000000 512.0100 0.4448
Subtotal (Total Children Is Unduplicated) 46 1176.750000 799.5100 0.6794
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Total 1827.250000 28885.7600 15.8083
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Number of Children (Unduplicated) With at Least One Service 90
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Center 52
Flag Claims Units Chgs Paid
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R 6 12.000000 900.0000 220.0000
U 0 0.000000 0.0000 0.0000
B 179 222.500000 10952.5000 1677.5000
P 108 103.750000 3819.4600 3819.4600
D 0 0.000000 0.0000 0.0000
S 2 4.000000 185.2900 35.2900
H 0 0.000000 0.0000 0.0000
T 102 1158.750000 3884.5400 3539.7200
296 326.250000 9143.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 693 1827.250000 28885.7600 9291.9700