CMS/EIP Fiscal Report Center: 55
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 111 131.250000 4856.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 15.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 109 475.500000 17593.5000 37.0000
Subtotal (Total Children Is Unduplicated) 113 622.250000 22449.7500 36.0783
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 7.000000 350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 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 69 137.999999 10350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 53 105.999999 7950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 34.657600 2599.3200 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 58.000000 3219.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.342400 175.6800 75.0000
Subtotal (Total Children Is Unduplicated) 102 378.999998 27041.0000 71.3483
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Total 1001.249998 49490.7500 49.4290
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Number of Children (Unduplicated) With at Least One Service 113
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Center 55
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 85 121.750000 5720.7500 0.0000
P 316 381.842799 17605.2100 17444.2100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
455 493.657199 25864.7900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 858 1001.249998 49490.7500 17444.2100