CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 09/30/2018 Date of Report:11/06/2018 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 46 47.750000 1766.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 60 69.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 64 278.500000 10295.2500 36.9668
Subtotal (Total Children Is Unduplicated) 65 396.000000 12062.0000 30.4596
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Screening, Eval, and Assessment,Class #02
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 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 8.500000 637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 66.000000 3663.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 71.000000 5325.0000 75.0000
Subtotal (Total Children Is Unduplicated) 57 175.500000 11729.2500 66.8333
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 50 53.250000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 57 113.000000 1130.0000 10.0000
TRAV-TRAVS-Travel by mile 18 203.000000 90.3900 0.4453
Subtotal (Total Children Is Unduplicated) 58 370.250000 1270.3900 3.4312
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Total 941.750000 25061.6400 26.6118
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Number of Children (Unduplicated) With at Least One Service 72
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Center 53
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 88 98.250000 4285.5000 0.0000
P 134 157.000000 7567.5000 7567.5000
D 3 5.500000 373.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 21 63.500000 559.4900 559.4900
T 17 78.000000 230.8300 230.8300
518 518.500000 10635.5700 0.0000
Other 15 21.000000 1409.2500 0.0000
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Total 796 941.750000 25061.6400 8357.8200