CMS/EIP Fiscal Report Center: 10
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 51 48.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 118 503.000000 18539.0000 36.8569
Subtotal (Total Children Is Unduplicated) 118 551.250000 18539.0000 33.6308
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 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 69 125.500000 9412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 43.500000 3262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 72 125.000000 6937.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 24.000000 1800.0000 75.0000
Subtotal (Total Children Is Unduplicated) 97 346.000000 23415.0000 67.6734
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Total 897.250000 41954.0000 46.7584
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Number of Children (Unduplicated) With at Least One Service 122
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Center 10
Flag Claims Units Chgs Paid
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R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 387 473.250000 22706.2500 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
338 421.250000 19146.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 726 897.250000 41954.0000 0.0000