CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 129 174.250000 6447.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 83 57.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 153 448.750000 16603.7500 37.0000
Subtotal (Total Children Is Unduplicated) 164 680.750000 23051.0000 33.8612
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 247.5000 70.7143
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 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 107.000000 7793.5400 72.8368
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 55.000000 3938.7500 71.6136
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 49.000000 3530.0000 72.0408
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 125.000000 6909.7500 55.2780
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 68 89.500000 6675.0000 74.5810
Subtotal (Total Children Is Unduplicated) 161 440.500000 29879.0400 67.8298
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EI Services,Class #03
INTR-T1013-INTERPRETER 15 16.250000 812.5000 50.0000
Subtotal (Total Children Is Unduplicated) 15 16.250000 812.5000 50.0000
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Total 1137.500000 53742.5400 47.2462
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Number of Children (Unduplicated) With at Least One Service 175
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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 6 9.000000 519.0000 0.0000
P 907 1088.250000 50368.2900 50365.7900
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
29 40.250000 2855.2500 40.0000
Other 0 0.000000 0.0000 0.0000
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Total 942 1137.500000 53742.5400 50405.7900