CMS/EIP Fiscal Report Center: 02
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 48 48.750000 1803.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 110.250000 4079.2500 37.0000
Subtotal (Total Children Is Unduplicated) 48 197.000000 5883.0000 29.8629
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Screening, Eval, and Assessment,Class #02
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 12 20.500000 1537.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 33.000000 1831.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
Subtotal (Total Children Is Unduplicated) 26 70.000000 4567.5000 65.2500
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 3.500000 175.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
TRAV-TRAVS-Travel by mile 31 2011.000000 894.7800 0.4449
Subtotal (Total Children Is Unduplicated) 32 2015.500000 1079.7800 0.5357
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Total 2282.500000 11530.2800 5.0516
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Number of Children (Unduplicated) With at Least One Service 49
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Center 02
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 43 1047.000000 2446.2100 2446.2100
0 0.000000 0.0000 0.0000
Other 405 1235.500000 9084.0700 0.0000
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Total 448 2282.500000 11530.2800 2446.2100