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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 502 286.250000 10591.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 145 117.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 590 2429.250000 89882.2500 37.0000
Subtotal (Total Children Is Unduplicated) 984 2832.500000 100473.5000 35.4717
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 134 239.000000 11950.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 28.000000 2100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 31.000000 1720.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 6.000000 450.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 169 315.500000 16927.8500 53.6540
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 28.000000 2000.3200 71.4400
Subtotal (Total Children Is Unduplicated) 3 28.000000 2000.3200 71.4400
-----------------------------------------------------------------------------------------------------------------------
Total 3176.000000 119401.6700 37.5950
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1028
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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
3137 3176.000000 119401.6700 2030.9800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3137 3176.000000 119401.6700 2030.9800