CMS/EIP Fiscal Report Center: 52
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 34 16.750000 619.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 23 14.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 93 377.750000 13736.2500 36.3633
Subtotal (Total Children Is Unduplicated) 95 409.000000 14356.0000 35.1002
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 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 58 121.000000 8455.0500 69.8764
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 70.000000 5250.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 27.000000 1910.2900 70.7515
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 128.000000 7093.6500 55.4191
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 72 364.000000 23961.4900 65.8283
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 1.500000 0.0000 0.0000
TRAV-TRAVS-Travel by mile 46 1062.000000 472.7400 0.4451
Subtotal (Total Children Is Unduplicated) 47 1063.500000 472.7400 0.4445
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Total 1836.500000 38790.2300 21.1218
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Number of Children (Unduplicated) With at Least One Service 95
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Center 52
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 78 112.250000 6386.2500 0.0000
P 195 234.250000 10221.7500 9814.0300
D 1 2.000000 111.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 23 43.500000 2862.7500 0.0000
T 100 1127.000000 4576.5600 4495.5600
321 317.500000 14631.9200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 718 1836.500000 38790.2300 14309.5900