CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 06/30/2019 Date of Report:07/21/2019 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 218 389.500000 14337.5000 36.8100
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 273 382.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 283 1494.000000 55130.0000 36.9009
Subtotal (Total Children Is Unduplicated) 283 2266.250000 69467.5000 30.6531
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 19.500000 1082.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 78.499999 5812.4999 74.0446
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 43.500000 3262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 34.500000 2587.5001 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 208 323.500300 17843.2667 55.1569
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 164 265.500000 19912.5000 75.0000
Subtotal (Total Children Is Unduplicated) 264 791.500299 52488.0167 66.3146
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.000000 150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.250000 162.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 0.500000 25.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.750000 37.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 240 269.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 12.000000 600.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 266 553.000000 5530.0000 10.0000
TRAV-TRAVS-Travel by mile 86 917.000000 408.0700 0.4450
Subtotal (Total Children Is Unduplicated) 267 1759.750000 6963.0700 3.9569
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Total 4817.500299 128918.5867 26.7605
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Number of Children (Unduplicated) With at Least One Service 285
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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 368 387.500000 17233.2500 27.7500
P 920 1024.529798 47042.9165 47082.7200
D 17 22.500000 1279.5000 0.0000
S 21 24.500000 888.0000 851.0000
H 155 652.750000 2280.7700 2280.7700
T 76 319.750000 1095.8000 1095.8000
2729 2309.970501 54057.1002 0.0000
Other 50 76.000000 5041.2500 0.0000
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Total 4336 4817.500299 128918.5867 51338.0400