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
Payclass Filters:GR
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 209 577.500000 21330.5000 36.9359
Subtotal (Total Children Is Unduplicated) 634 1569.250000 49718.7500 31.6831
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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 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 27.000000 1498.5000 55.5000
Subtotal (Total Children Is Unduplicated) 69 70.000000 3704.0000 52.9143
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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 6 28.000000 1400.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 12.750000 910.8600 71.4400
Subtotal (Total Children Is Unduplicated) 11 43.750000 2460.8600 56.2482
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Total 1683.000000 55883.6100 33.2048
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Number of Children (Unduplicated) With at Least One Service 665
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Center 51
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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
2700 1683.000000 55883.6100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2700 1683.000000 55883.6100 0.0000