CMS/EIP Fiscal Report Center: 54
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 32 19.750000 730.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 144 155.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 163 672.750000 24799.2500 36.8625
Subtotal (Total Children Is Unduplicated) 165 848.000000 25530.0000 30.1061
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 20.500000 1137.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 132.000000 9900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 33.500000 2512.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 134.000000 7437.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 31.000000 2325.0000 75.0000
Subtotal (Total Children Is Unduplicated) 137 387.500000 26049.7500 67.2252
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.500000 75.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 111 128.250000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 138 277.000000 2770.0000 10.0000
TRAV-TRAVS-Travel by mile 81 2116.000000 941.8600 0.4451
Subtotal (Total Children Is Unduplicated) 138 2523.750000 3811.8600 1.5104
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Total 3759.250000 55391.6100 14.7348
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Number of Children (Unduplicated) With at Least One Service 165
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Center 54
Flag Claims Units Chgs Paid
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R 150 156.750000 6852.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 333 317.250000 15207.5000 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 78 779.500000 1052.0600 1052.0600
T 88 755.500000 1337.1700 1327.1700
1143 1750.250000 30942.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1792 3759.250000 55391.6100 2379.2300