CMS/EIP Fiscal Report Center: 09
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 103 193.000000 7141.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 70 46.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 173 443.500000 16409.5000 37.0000
Subtotal (Total Children Is Unduplicated) 181 683.250000 23550.5000 34.4684
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 110.500000 8237.5000 74.5475
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 77.000000 5775.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 93.000000 6975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 120 196.500000 10905.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 51.000000 3825.0000 75.0000
Subtotal (Total Children Is Unduplicated) 178 573.500000 38760.2500 67.5854
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 7 5.000000 0.0000 0.0000
INTR-T1013-INTERPRETER 7 7.750000 387.5000 50.0000
TRAV-TRAVS-Travel by mile 8 235.000000 103.3700 0.4399
Subtotal (Total Children Is Unduplicated) 22 247.750000 490.8700 1.9813
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Total 1504.500000 62801.6200 41.7425
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Number of Children (Unduplicated) With at Least One Service 191
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Center 09
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 7 8.500000 371.5000 0.0000
P 676 1124.000000 41584.8700 41638.9700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 207 274.000000 13690.2500 0.0000
T 0 0.000000 0.0000 0.0000
7 11.000000 786.0000 0.0000
Other 55 87.000000 6369.0000 0.0000
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Total 952 1504.500000 62801.6200 41638.9700