CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 83 95.750000 3542.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 70 40.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 134 375.000000 13875.0000 37.0000
Subtotal (Total Children Is Unduplicated) 138 510.750000 17417.7500 34.1023
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 207.5000 59.2857
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 57 78.000000 5442.0800 69.7703
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 40.000000 2935.0000 73.3750
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 88.500000 6625.2700 74.8618
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 88.500000 4818.5000 54.4463
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 77.500000 5724.8900 73.8695
Subtotal (Total Children Is Unduplicated) 135 387.500000 26566.9900 68.5600
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EI Services,Class #03
INTR-T1013-INTERPRETER 5 6.000000 300.0000 50.0000
TRAV-TRAVS-Travel by mile 1 46.000000 20.4700 0.4450
Subtotal (Total Children Is Unduplicated) 6 52.000000 320.4700 6.1629
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Total 950.250000 44305.2100 46.6248
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Number of Children (Unduplicated) With at Least One Service 142
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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 9 17.500000 818.5000 0.0000
P 582 761.750000 31967.8800 31967.8800
D 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.750000 27.7500 27.7500
84 110.250000 7059.3300 112.5000
Other 47 59.000000 4376.2500 0.0000
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Total 724 950.250000 44305.2100 32108.1300