CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 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 46 48.500000 1794.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 208.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 63 286.250000 10554.2500 36.8707
Subtotal (Total Children Is Unduplicated) 65 543.000000 12348.7500 22.7417
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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-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 11.000000 825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 58.000000 3219.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 64.500000 4837.5000 75.0000
Subtotal (Total Children Is Unduplicated) 54 157.000000 10458.7500 66.6162
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 54 102.000000 1020.0000 10.0000
TRAV-TRAVS-Travel by mile 14 207.000000 92.1600 0.4452
Subtotal (Total Children Is Unduplicated) 54 309.000000 1112.1600 3.5992
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Total 1009.000000 23919.6600 23.7063
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Number of Children (Unduplicated) With at Least One Service 65
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Center 53
Flag Claims Units Chgs Paid
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R 1 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 80 84.500000 4072.0000 0.0000
P 152 183.750000 8602.5000 8602.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 46.000000 87.3700 87.3700
T 1 1.000000 37.0000 0.0000
518 690.750000 10999.7900 0.0000
Other 1 1.000000 10.0000 0.0000
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Total 764 1009.000000 23919.6600 8689.8700