CMS/EIP Fiscal Report Center: 52
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 6 1.500000 55.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 13 5.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 43 177.250000 6558.2500 37.0000
Subtotal (Total Children Is Unduplicated) 44 184.500000 6613.7500 35.8469
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 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 35 72.000000 5165.0000 71.7361
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 32.000000 2177.7200 68.0538
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 26.000000 1893.1500 72.8135
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 68.500000 3801.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 37 212.000000 13972.1200 65.9062
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 5.000000 50.0000 10.0000
TRAV-TRAVS-Travel by mile 30 706.000000 314.0900 0.4449
Subtotal (Total Children Is Unduplicated) 31 711.000000 364.0900 0.5121
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Total 1107.500000 20949.9600 18.9164
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Number of Children (Unduplicated) With at Least One Service 44
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Center 52
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 9 16.500000 1066.5000 150.0000
P 73 110.500000 5641.5000 5438.9800
D 0 0.000000 0.0000 0.0000
S 21 20.750000 841.7500 0.0000
H 11 21.500000 1612.5000 0.0000
T 86 772.500000 4034.8700 3839.8700
115 165.750000 7752.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 315 1107.500000 20949.9600 9428.8500