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
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 910 857.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3438 9821.750000 363386.2500 36.9981
Subtotal (Total Children Is Unduplicated) 3442 10678.75000 363386.2500 34.0289
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.500000 637.5000 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 10 19.500000 1082.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 437 827.000000 62025.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 187 330.500000 24758.2500 74.9115
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 112 183.500000 13762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 468 906.500000 50310.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 126.500000 9487.5000 75.0000
Subtotal (Total Children Is Unduplicated) 623 2427.000000 163888.7500 67.5273
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Total 13105.750000 527275.0000 40.2323
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Number of Children (Unduplicated) With at Least One Service 3443
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Center 10
Flag Claims Units Chgs Paid
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R 180 151.000000 5587.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3446 2783.750000 114474.7500 18.5000
P 5902 4773.250000 202437.5000 201709.9580
D 8 7.500000 277.5000 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
6180 5389.750000 204479.7500 0.0000
Other 1 0.500000 18.5000 0.0000
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Total 15717 13105.750000 527275.0000 201728.4580