CMS/EIP Fiscal Report Center: 05
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 659 1434.750000 53085.7500 37.0000
Subtotal (Total Children Is Unduplicated) 659 1434.750000 53085.7500 37.0000
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Screening, Eval, and Assessment,Class #02
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 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 54.500000 4087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
Subtotal (Total Children Is Unduplicated) 41 62.000000 4572.0000 73.7419
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 18.500000 925.0000 50.0000
Subtotal (Total Children Is Unduplicated) 8 24.500000 1075.0000 43.8776
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Total 1521.250000 58732.7500 38.6082
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Number of Children (Unduplicated) With at Least One Service 660
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Center 05
Flag Claims Units Chgs Paid
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R 15 11.250000 501.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2310 1501.750000 57926.5000 41575.2400
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
12 8.250000 305.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2337 1521.250000 58732.7500 41575.2400