CMS/EIP Fiscal Report Center: 09
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 77 83.750000 3098.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 60 32.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 118 361.250000 13366.2500 37.0000
Subtotal (Total Children Is Unduplicated) 118 477.000000 16465.0000 34.5178
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 67.500000 5062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 37.500000 2628.7500 70.1000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 75.500000 5595.0200 74.1062
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 106.500000 5812.7500 54.5798
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 55.000000 4043.0200 73.5095
Subtotal (Total Children Is Unduplicated) 114 358.000000 24244.5400 67.7222
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 5 8.000000 0.0000 0.0000
INTR-T1013-INTERPRETER 7 16.000000 800.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 9 404.000000 179.8000 0.4450
Subtotal (Total Children Is Unduplicated) 19 429.000000 1051.2400 2.4504
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Total 1264.000000 41760.7800 33.0386
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Number of Children (Unduplicated) With at Least One Service 126
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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 0 0.000000 0.0000 0.0000
P 569 1161.000000 34538.0300 34538.0300
D 1 2.000000 111.0000 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
17 27.500000 1706.5000 0.0000
Other 50 73.500000 5405.2500 0.0000
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Total 637 1264.000000 41760.7800 34538.0300