CMS/EIP Fiscal Report Center: 06
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 69 48.000000 1776.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 11.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 83 255.000000 9435.0000 37.0000
Subtotal (Total Children Is Unduplicated) 85 314.750000 11211.0000 35.6187
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 23.500000 1762.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 27.500000 2062.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 56.000000 3108.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 37.500000 2812.5000 75.0000
Subtotal (Total Children Is Unduplicated) 66 162.500000 11095.5000 68.2800
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 160.0000 80.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 6.000000 60.0000 10.0000
Subtotal (Total Children Is Unduplicated) 3 12.000000 420.0000 35.0000
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Total 489.250000 22726.5000 46.4517
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Number of Children (Unduplicated) With at Least One Service 85
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Center 06
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 7 8.000000 220.0000 220.0000
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 0 0.000000 0.0000 0.0000
575 481.250000 22506.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 582 489.250000 22726.5000 220.0000