CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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 60 90.750000 3357.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 78 188.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 84 373.000000 13754.7500 36.8760
Subtotal (Total Children Is Unduplicated) 84 652.250000 17112.5000 26.2361
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
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 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 74.000000 4107.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 99.000000 7462.5000 75.3788
Subtotal (Total Children Is Unduplicated) 70 206.000000 13965.2500 67.7925
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 0.500000 25.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 3.000000 150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 72 142.000000 1420.0000 10.0000
TRAV-TRAVS-Travel by mile 21 228.000000 101.5100 0.4452
Subtotal (Total Children Is Unduplicated) 72 374.500000 1746.5100 4.6636
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Total 1232.750000 32824.2600 26.6269
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Number of Children (Unduplicated) With at Least One Service 84
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Center 53
Flag Claims Units Chgs Paid
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R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 33 37.000000 1989.0000 83.2500
P 271 319.000000 14699.2500 14699.2500
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 56 264.000000 877.5100 877.5100
700 608.750000 14988.2500 0.0000
Other 2 3.000000 233.2500 0.0000
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Total 1064 1232.750000 32824.2600 15660.0100