CMS/EIP Fiscal Report Center: 57
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 28 14.250000 527.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 24 20.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 94 503.000000 18611.0000 37.0000
Subtotal (Total Children Is Unduplicated) 98 537.750000 19138.2500 35.5895
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 45.000000 3375.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 74 89.500000 4967.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
Subtotal (Total Children Is Unduplicated) 81 188.000000 12140.2500 64.5758
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 8.000000 80.0000 10.0000
Subtotal (Total Children Is Unduplicated) 4 8.000000 80.0000 10.0000
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Total 733.750000 31358.5000 42.7373
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Number of Children (Unduplicated) With at Least One Service 98
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Center 57
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 17 28.250000 1073.0000 0.0000
P 229 333.500000 14691.0000 14661.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.000000 225.0000 0.0000
T 12 16.000000 602.0000 602.0000
272 353.000000 14767.5000 456.7500
Other 0 0.000000 0.0000 0.0000
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Total 533 733.750000 31358.5000 15720.5000