CMS/EIP Fiscal Report Center: 51
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 34 66.500000 2460.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 20 22.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 35 129.750000 4763.7500 36.7148
Subtotal (Total Children Is Unduplicated) 38 219.000000 7224.2500 32.9874
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 14.500000 1087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 25.500000 1415.2500 55.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 28 51.000000 3277.7500 64.2696
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 7.000000 70.0000 10.0000
Subtotal (Total Children Is Unduplicated) 7 7.000000 70.0000 10.0000
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Total 277.000000 10572.0000 38.1661
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Number of Children (Unduplicated) With at Least One Service 45
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Center 51
Flag Claims Units Chgs Paid
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R 2 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 43 34.250000 1498.7500 0.0000
P 19 19.000000 892.0000 892.0000
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
294 221.750000 8070.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 358 277.000000 10572.0000 892.0000