CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 956 870.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2751 7975.250000 295046.0000 36.9952
Subtotal (Total Children Is Unduplicated) 2752 8845.250000 295046.0000 33.3564
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.500000 1312.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 309 571.000000 42825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 127 219.000000 16425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 100 166.500000 12487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 270 472.500000 26223.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 125 202.500000 15187.5000 75.0000
Subtotal (Total Children Is Unduplicated) 454 1677.500000 116306.2500 69.3331
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Total 10522.750000 411352.2500 39.0917
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Number of Children (Unduplicated) With at Least One Service 2754
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Center 10
Flag Claims Units Chgs Paid
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R 73 44.000000 1628.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8713 6034.500000 251044.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 71 38.250000 1415.2500 0.0000
S 177 138.500000 5124.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5633 4267.250000 152130.7500 0.0000
Other 1 0.250000 9.2500 0.0000
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Total 14668 10522.750000 411352.2500 0.0000