CMS/EIP Fiscal Report Center: 10
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 61 60.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 168 661.000000 24457.0000 37.0000
Subtotal (Total Children Is Unduplicated) 168 721.000000 24457.0000 33.9209
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 142.500000 10687.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 55.000000 4125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 89 163.500000 9074.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 15.000000 1125.0000 75.0000
Subtotal (Total Children Is Unduplicated) 112 402.000000 26844.7500 66.7780
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 4.000000 120.0000 30.0000
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Total 1127.000000 51421.7500 45.6271
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Number of Children (Unduplicated) With at Least One Service 169
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Center 10
Flag Claims Units Chgs Paid
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R 9 12.750000 471.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 172 191.250000 8244.7500 0.0000
P 279 326.250000 15926.0000 15926.0000
D 2 3.500000 129.5000 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
503 593.250000 26649.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 965 1127.000000 51421.7500 15926.0000