CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 29 13.000000 481.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 41 42.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 123 496.250000 18361.2500 37.0000
Subtotal (Total Children Is Unduplicated) 123 551.500000 18842.2500 34.1655
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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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 58.500000 4327.5000 73.9744
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 79 119.500000 6604.5000 55.2678
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 84.500000 6337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 94 275.000000 18138.7500 65.9591
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
INTR-T1013-INTERPRETER 22 41.250000 2037.5000 49.3939
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 6.000000 60.0000 10.0000
TRAV-TRAVS-Travel by mile 16 583.000000 248.2800 0.4259
Subtotal (Total Children Is Unduplicated) 36 632.250000 2445.7800 3.8684
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Total 1458.750000 39426.7800 27.0278
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Number of Children (Unduplicated) With at Least One Service 123
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Center 01
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 1 0.500000 18.5000 0.0000
P 81 631.000000 3908.3000 3908.3000
D 1 1.500000 112.5000 0.0000
S 102 132.500000 5204.9800 0.0000
H 260 242.500000 11022.2500 9835.0000
T 2 2.500000 187.5000 187.5000
455 382.750000 14762.2500 0.0000
Other 43 65.500000 4210.5000 0.0000
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Total 945 1458.750000 39426.7800 13930.8000