CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 21 7.500000 277.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 46 41.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 92 343.750000 12718.7500 37.0000
Subtotal (Total Children Is Unduplicated) 93 393.000000 12996.2500 33.0693
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 34.500000 2459.5700 71.2919
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 10.000000 750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 46.500000 2525.2500 54.3065
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 17.500000 1128.6400 64.4937
Subtotal (Total Children Is Unduplicated) 51 128.500000 8324.4600 64.7818
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 250.0000 50.0000
INTR-T1013-INTERPRETER 15 30.000000 1500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 10.000000 100.0000 10.0000
TRAV-TRAVS-Travel by mile 20 632.000000 274.0800 0.4337
Subtotal (Total Children Is Unduplicated) 28 679.000000 2224.0800 3.2755
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Total 1200.500000 23544.7900 19.6125
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Number of Children (Unduplicated) With at Least One Service 93
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Center 01
Flag Claims Units Chgs Paid
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R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 261 240.750000 9711.5000 0.0000
P 92 700.250000 3350.0400 3350.0400
D 2 1.250000 87.5000 0.0000
S 6 4.000000 262.0000 0.0000
H 4 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
279 228.750000 8387.0000 0.0000
Other 12 17.500000 1146.7500 0.0000
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Total 657 1200.500000 23544.7900 3350.0400