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
Payclass Filters:GR
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 68 206.750000 7649.7500 37.0000
Subtotal (Total Children Is Unduplicated) 156 438.750000 14097.0000 32.1299
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 60.0000 60.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 30.500000 2101.0400 68.8866
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 11.000000 638.7500 58.0682
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 14.000000 905.0000 64.6429
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 48.500000 2691.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 44.500000 3337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 68 152.000000 9921.5400 65.2733
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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 607.000000 24831.0400 40.9078
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Number of Children (Unduplicated) With at Least One Service 167
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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 0 0.000000 0.0000 0.0000
P 568 601.000000 24421.0400 24418.5400
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
4 6.000000 410.0000 40.0000
Other 0 0.000000 0.0000 0.0000
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Total 572 607.000000 24831.0400 24458.5400