CMS/EIP Fiscal Report Center: 09
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 97 157.250000 5818.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 107 72.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 203 516.000000 19018.0000 36.8566
Subtotal (Total Children Is Unduplicated) 208 745.250000 24836.2500 33.3261
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.500000 937.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 19.500000 1082.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 90 137.500000 10312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 90.500000 6674.1700 73.7477
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 97.000000 7201.0000 74.2371
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 225.500000 12415.2500 55.0565
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 76.500000 5550.6500 72.5575
Subtotal (Total Children Is Unduplicated) 204 670.000000 44998.3200 67.1617
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 7 5.500000 0.0000 0.0000
INTR-T1013-INTERPRETER 7 11.000000 550.0000 50.0000
TRAV-TRAVS-Travel by mile 8 475.000000 205.5100 0.4327
Subtotal (Total Children Is Unduplicated) 20 491.500000 755.5100 1.5372
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Total 1906.750000 70590.0800 37.0212
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Number of Children (Unduplicated) With at Least One Service 210
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Center 09
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 11 17.250000 713.2500 0.0000
P 618 1245.750000 38329.4500 38528.1700
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 303 401.500000 19634.5000 0.0000
T 1 2.000000 111.0000 166.5000
28 113.750000 2489.8800 0.0000
Other 77 124.500000 9162.0000 0.0000
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Total 1039 1906.750000 70590.0800 38694.6700