CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 27 13.500000 499.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 40 36.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 116 494.000000 18278.0000 37.0000
Subtotal (Total Children Is Unduplicated) 116 543.500000 18777.5000 34.5492
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 53.000000 3892.9000 73.4509
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 83.500000 4634.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 75.000000 5625.0000 75.0000
Subtotal (Total Children Is Unduplicated) 82 229.500000 15443.6500 67.2926
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EI Services,Class #03
INTR-T1013-INTERPRETER 23 32.750000 1637.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 30.0000 10.0000
TRAV-TRAVS-Travel by mile 20 647.000000 276.5300 0.4274
Subtotal (Total Children Is Unduplicated) 39 682.750000 1944.0300 2.8474
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Total 1455.750000 36165.1800 24.8430
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Number of Children (Unduplicated) With at Least One Service 116
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Center 01
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 67 677.000000 2729.8400 2729.8400
D 2 3.000000 123.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 464 428.250000 19045.7500 17403.2500
T 1 12.000000 4.9400 4.9400
336 250.000000 8784.7500 0.0000
Other 61 85.500000 5476.5000 0.0000
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Total 931 1455.750000 36165.1800 20138.0300