CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 40 15.750000 582.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 39 38.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 128 496.500000 18296.5000 36.8510
Subtotal (Total Children Is Unduplicated) 128 550.500000 18879.2500 34.2947
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 36.500000 2737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.500000 337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 106.000000 5855.2500 55.2382
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 87.500000 6491.5700 74.1894
Subtotal (Total Children Is Unduplicated) 92 255.500000 16831.0700 65.8750
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 12.000000 600.0000 50.0000
INTR-T1013-INTERPRETER 23 40.750000 2037.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 20.000000 200.0000 10.0000
TRAV-TRAVS-Travel by mile 12 392.000000 167.2000 0.4265
Subtotal (Total Children Is Unduplicated) 34 465.750000 3054.7000 6.5587
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Total 1271.750000 38765.0200 30.4816
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Number of Children (Unduplicated) With at Least One Service 128
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Center 01
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 14 18.000000 1206.7500 0.0000
P 87 461.500000 3082.5200 3082.5200
D 0 0.000000 0.0000 0.0000
S 170 161.500000 7344.7500 0.0000
H 316 280.500000 12484.2500 11223.5000
T 1 1.500000 75.0000 75.0000
391 285.250000 10501.5000 0.0000
Other 43 63.500000 4070.2500 0.0000
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Total 1022 1271.750000 38765.0200 14381.0200