CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:GR
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 31 13.500000 499.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 24 25.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21 73.000000 2701.0000 37.0000
Subtotal (Total Children Is Unduplicated) 39 111.750000 3200.5000 28.6398
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 11.500000 862.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 11.000000 610.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 15 37.000000 2560.5000 69.2027
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10 14.000000 140.0000 10.0000
TRAV-TRAVS-Travel by mile 18 462.000000 205.5500 0.4449
Subtotal (Total Children Is Unduplicated) 18 476.000000 345.5500 0.7259
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Total 624.750000 6106.5500 9.7744
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Number of Children (Unduplicated) With at Least One Service 40
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Center 05
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 60 511.000000 2756.0500 2756.0500
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
175 113.750000 3350.5000 150.0000
Other 0 0.000000 0.0000 0.0000
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Total 235 624.750000 6106.5500 2906.0500