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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 577 768.500000 28388.2500 36.9398
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 195 223.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 561 1547.000000 57192.7500 36.9701
Subtotal (Total Children Is Unduplicated) 689 2538.750000 85581.0000 33.7099
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 40 40.000000 2000.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 78.500000 4356.7500 55.5000
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 131 136.500000 7484.2500 54.8297
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 54.000000 2700.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 91.750000 5706.3400 62.1944
Subtotal (Total Children Is Unduplicated) 28 148.750000 8556.3400 57.5216
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Total 2824.000000 101621.5900 35.9850
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Number of Children (Unduplicated) With at Least One Service 737
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Center 51
Flag Claims Units Chgs Paid
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R 3 3.000000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 387.750000 15292.5000 0.0000
P 38 38.000000 2062.5000 2193.0000
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
3741 2395.250000 84100.0900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4375 2824.000000 101621.5900 2193.0000