CMS/EIP Fiscal Report Center: 53
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 54 79.500000 2941.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 94.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 79 343.500000 12672.5000 36.8923
Subtotal (Total Children Is Unduplicated) 81 517.250000 15614.0000 30.1866
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 13.500000 1012.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 85.500000 4689.7500 54.8509
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 55.000000 4125.0000 75.0000
Subtotal (Total Children Is Unduplicated) 63 192.000000 12521.2500 65.2148
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.250000 62.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.750000 37.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 57 73.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 9.000000 450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 65 143.000000 1430.0000 10.0000
TRAV-TRAVS-Travel by mile 18 472.000000 210.1000 0.4451
Subtotal (Total Children Is Unduplicated) 65 700.750000 2252.6000 3.2146
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Total 1410.000000 30387.8500 21.5517
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Number of Children (Unduplicated) With at Least One Service 86
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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 64 73.500000 3176.7500 27.7500
P 202 242.000000 11417.7500 11417.7500
D 0 0.000000 0.0000 0.0000
S 2 1.500000 55.5000 0.0000
H 16 111.250000 138.3500 138.3500
T 35 273.500000 512.7200 512.7200
671 672.250000 12748.7800 0.0000
Other 23 36.000000 2338.0000 0.0000
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Total 1013 1410.000000 30387.8500 12096.5700