CMS/EIP Fiscal Report Center: 09
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 102 173.250000 6410.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 116 71.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 207 530.000000 19563.7500 36.9127
Subtotal (Total Children Is Unduplicated) 211 774.500000 25974.0000 33.5365
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 379.0000 54.1429
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 95 136.000000 10185.0000 74.8897
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 53 86.500000 6487.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 66 106.500000 7942.9600 74.5818
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 152 243.000000 13486.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 71.500000 5315.0000 74.3357
Subtotal (Total Children Is Unduplicated) 212 671.500000 45195.4600 67.3052
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 6 4.250000 0.0000 0.0000
INTR-T1013-INTERPRETER 9 28.250000 1412.5000 50.0000
TRAV-TRAVS-Travel by mile 8 375.000000 164.2200 0.4379
Subtotal (Total Children Is Unduplicated) 20 407.500000 1576.7200 3.8693
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Total 1853.500000 72746.1800 39.2480
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Number of Children (Unduplicated) With at Least One Service 216
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Center 09
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 13 20.000000 1025.0000 0.0000
P 790 1429.250000 48034.6800 48034.6800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 197 250.500000 12525.5000 0.0000
T 2 3.000000 195.7500 187.5000
19 27.250000 1897.7500 0.0000
Other 76 123.500000 9067.5000 0.0000
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Total 1097 1853.500000 72746.1800 48222.1800