CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 83 127.500000 4717.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 63 43.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 136 482.250000 17843.2500 37.0000
Subtotal (Total Children Is Unduplicated) 137 652.750000 22560.7500 34.5626
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 59 84.500000 6252.5000 73.9941
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 21.500000 1577.5000 73.3721
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 74 119.000000 8925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 74 124.000000 6812.0000 54.9355
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 57 82.000000 5989.0000 73.0366
Subtotal (Total Children Is Unduplicated) 139 451.000000 30948.7500 68.6225
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 9 10.000000 0.0000 0.0000
INTR-T1013-INTERPRETER 11 16.750000 823.5000 49.1642
TRAV-TRAVS-Travel by mile 10 471.000000 209.6100 0.4450
Subtotal (Total Children Is Unduplicated) 25 497.750000 1033.1100 2.0756
-----------------------------------------------------------------------------------------------------------------------
Total 1601.500000 54542.6100 34.0572
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 144
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 633 1372.250000 39573.1100 39573.1120
D 1 1.500000 112.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 23.000000 1559.2500 0.0000
T 0 0.000000 0.0000 0.0000
51 74.750000 3723.2500 0.0000
Other 84 128.000000 9424.5000 0.0000
---------------------------------------------------------
Total 784 1601.500000 54542.6100 39573.1120