CMS/EIP Fiscal Report Center: 57
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
CASE-CASE-NON-TCM CASE MANAGEMENT 226 99.000000 3663.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 58.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1421 4982.250000 184343.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1424 5139.500000 188006.2500 36.5807
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 98 178.000000 8900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 6.500000 360.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 196 180.500000 13537.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 236 232.000000 12876.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 85 83.500000 6262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 368 696.000000 43074.2500 61.8883
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Total 5835.500000 231080.5000 39.5991
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Number of Children (Unduplicated) With at Least One Service 1442
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Center 57
Flag Claims Units Chgs Paid
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R 3 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2550 2410.500000 98379.2500 0.0000
P 914 929.750000 34513.7500 34169.5000
D 11 16.000000 592.0000 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
2767 2475.500000 97456.7500 0.0000
Other 1 0.750000 27.7500 0.0000
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Total 6246 5835.500000 231080.5000 34169.5000