CMS/EIP Fiscal Report Center: 06
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 47 42.750000 1581.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 36 31.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 52 211.750000 7834.7500 37.0000
Subtotal (Total Children Is Unduplicated) 53 286.000000 9416.5000 32.9248
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 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 31 38.000000 2850.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 15.000000 1125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 13.000000 975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 44 111.000000 7535.2500 67.8851
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.000000 130.0000 65.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
Subtotal (Total Children Is Unduplicated) 2 4.000000 150.0000 37.5000
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Total 401.000000 17101.7500 42.6478
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Number of Children (Unduplicated) With at Least One Service 53
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Center 06
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
475 401.000000 17101.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 475 401.000000 17101.7500 0.0000