CMS/EIP Fiscal Report Center: 57
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 27 23.000000 851.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 15.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 71 450.500000 16668.5000 37.0000
Subtotal (Total Children Is Unduplicated) 74 488.750000 17519.5000 35.8455
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 58 60.500000 4537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 70.500000 3912.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 8.500000 637.5000 75.0000
Subtotal (Total Children Is Unduplicated) 63 144.000000 9346.0000 64.9028
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 9.000000 90.0000 10.0000
TRAV-TRAVS-Travel by mile 1 145.000000 64.5300 0.4450
Subtotal (Total Children Is Unduplicated) 3 160.000000 454.5300 2.8408
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Total 792.750000 27320.0300 34.4624
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Number of Children (Unduplicated) With at Least One Service 76
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Center 57
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 131 188.000000 7539.0000 0.0000
P 47 48.500000 3105.2500 3105.2500
D 1 1.000000 75.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 11 165.000000 790.5300 790.5300
295 390.250000 15810.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 485 792.750000 27320.0300 3895.7800