CMS/EIP Fiscal Report Center: 03
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 40 17.750000 656.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 26 26.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 68 271.250000 10036.2500 37.0000
Subtotal (Total Children Is Unduplicated) 68 315.500000 10693.0000 33.8922
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 61.500000 4612.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 25.000000 1875.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 45.500000 2525.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 55 151.000000 10334.7500 68.4421
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Total 466.500000 21027.7500 45.0756
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Number of Children (Unduplicated) With at Least One Service 68
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Center 03
Flag Claims Units Chgs Paid
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R 6 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 196 216.250000 9809.7500 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
246 244.750000 11014.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 448 466.500000 21027.7500 0.0000