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
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 75 50.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 85 146.000000 5402.0000 37.0000
Subtotal (Total Children Is Unduplicated) 86 196.750000 5402.0000 27.4562
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 49.500000 3712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 83.000000 6225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 135.500000 7520.2500 55.5000
Subtotal (Total Children Is Unduplicated) 83 285.000000 18596.2500 65.2500
-----------------------------------------------------------------------------------------------------------------------
Total 481.750000 23998.2500 49.8147
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 87
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 106 161.500000 8134.0000 8134.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 214 316.250000 15716.2500 0.0000
T 0 0.000000 0.0000 0.0000
4 4.000000 148.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 324 481.750000 23998.2500 8134.0000