CMS/EIP Fiscal Report Center: 52
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 17 11.000000 407.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 27 14.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 66 274.750000 10156.5000 36.9663
Subtotal (Total Children Is Unduplicated) 67 300.500000 10563.5000 35.1531
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 51 104.500000 7455.0000 71.3397
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 48.000000 3415.6500 71.1594
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 28.500000 2137.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 104.000000 5772.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 57 291.000000 19191.1500 65.9490
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 8.000000 80.0000 10.0000
TRAV-TRAVS-Travel by mile 44 1025.000000 455.9900 0.4449
Subtotal (Total Children Is Unduplicated) 44 1033.500000 535.9900 0.5186
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Total 1625.000000 30290.6400 18.6404
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Number of Children (Unduplicated) With at Least One Service 67
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Center 52
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 29 42.000000 2065.0000 0.0000
P 153 212.250000 10438.5000 10000.9800
D 1 2.000000 150.0000 0.0000
S 27 23.000000 703.0000 0.0000
H 16 29.500000 2085.7500 0.0000
T 107 1085.000000 3568.9100 3378.9100
170 231.250000 11279.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 503 1625.000000 30290.6400 13379.8900