CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 86 112.000000 4144.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 116 71.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 194 517.250000 19101.2500 36.9285
Subtotal (Total Children Is Unduplicated) 196 700.750000 23245.2500 33.1720
-----------------------------------------------------------------------------------------------------------------------
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 1 2.000000 150.0000 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 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 162.000000 11976.3000 73.9278
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 39 55.500000 4067.5000 73.2883
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 58 90.500000 6697.8700 74.0096
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 137 219.000000 12071.2500 55.1199
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 67.500000 4937.8700 73.1536
Subtotal (Total Children Is Unduplicated) 193 607.500000 40657.5400 66.9260
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 10.500000 0.0000 0.0000
INTR-T1013-INTERPRETER 10 18.500000 925.0000 50.0000
TRAV-TRAVS-Travel by mile 6 135.000000 60.0900 0.4451
Subtotal (Total Children Is Unduplicated) 22 164.000000 985.0900 6.0066
-----------------------------------------------------------------------------------------------------------------------
Total 1472.250000 64887.8800 44.0740
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 199
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 18.500000 684.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 76 135.000000 6259.0000 0.0000
P 778 1132.250000 44810.2600 44810.3200
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
49 75.500000 4926.1200 0.0000
Other 74 111.000000 8208.0000 0.0000
---------------------------------------------------------
Total 990 1472.250000 64887.8800 44810.3200