CMS/EIP Fiscal Report Center: 07
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 1051 2634.500000 97134.2500 36.8701
Subtotal (Total Children Is Unduplicated) 1051 2634.500000 97134.2500 36.8701
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 167.500000 12562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 96 191.500000 10628.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 85 168.000000 12600.0000 75.0000
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 186 570.000000 38599.9500 67.7192
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 50.0000 50.0000
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Total 3205.500000 135784.2000 42.3598
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Number of Children (Unduplicated) With at Least One Service 1059
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Center 07
Flag Claims Units Chgs Paid
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R 9 9.750000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2035 1740.250000 73773.7000 129.5000
P 1393 1331.500000 56822.7500 56981.5000
D 1 0.250000 9.2500 0.0000
S 4 5.500000 316.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
165 118.250000 4501.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3607 3205.500000 135784.2000 57111.0000