CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 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 63 85.500000 3145.0000 36.7836
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 82 88.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 95 379.250000 14032.2500 37.0000
Subtotal (Total Children Is Unduplicated) 96 553.500000 17177.2500 31.0339
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 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 18 27.000000 1950.0000 72.2222
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 75.000000 4107.0000 54.7600
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 81.500000 6112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 75 209.500000 14051.2500 67.0704
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 67 70.250000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 75 148.000000 1480.0000 10.0000
TRAV-TRAVS-Travel by mile 25 262.000000 116.5800 0.4450
Subtotal (Total Children Is Unduplicated) 75 480.250000 1596.5800 3.3245
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Total 1243.250000 32825.0800 26.4026
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Number of Children (Unduplicated) With at Least One Service 101
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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 110 117.000000 5472.7500 0.0000
P 183 197.750000 9209.7500 9074.8600
D 6 6.250000 334.5000 0.0000
S 8 7.750000 286.7500 286.7500
H 20 83.500000 280.3100 280.3100
T 20 112.000000 219.9400 219.9400
742 717.500000 16908.5800 0.0000
Other 1 1.500000 112.5000 0.0000
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Total 1090 1243.250000 32825.0800 9861.8600