CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1041 966.500000 35760.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1674 7791.250000 288276.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1711 8757.750000 324036.7500 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 62 63.750000 3187.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 112 101.750000 5087.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 24.000000 1800.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 48 58.000000 4350.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 41.000000 2275.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 109 84.000000 6300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 183 143.500000 10762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 324 382.500000 21228.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 185 186.000000 15211.1900 81.7806
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 570 1108.500000 71763.4400 64.7392
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Total 9866.250000 395800.1900 40.1166
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Number of Children (Unduplicated) With at Least One Service 1718
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Center 04
Flag Claims Units Chgs Paid
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R 498 753.000000 27861.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1004 1503.750000 59258.5000 46.2500
P 2713 4145.750000 164534.9400 162310.1300
D 1 1.500000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3897 3462.250000 144090.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8113 9866.250000 395800.1900 162356.3800