CMS/EIP Fiscal Report Center: 57
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 25 11.250000 416.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 22 12.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 75 372.250000 13773.2500 37.0000
Subtotal (Total Children Is Unduplicated) 76 396.250000 14189.5000 35.8095
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 34.000000 2550.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 57.500000 3191.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 51 113.000000 7334.2500 64.9049
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 16.000000 800.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 22.000000 220.0000 10.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 2.500000 92.5000 37.0000
Subtotal (Total Children Is Unduplicated) 5 40.500000 1112.5000 27.4691
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Total 549.750000 22636.2500 41.1755
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Number of Children (Unduplicated) With at Least One Service 76
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Center 57
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 14 26.250000 1046.2500 0.0000
P 103 139.500000 5990.0000 5901.2000
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 14 28.500000 573.5000 573.5000
281 355.500000 15026.5000 1322.0000
Other 0 0.000000 0.0000 0.0000
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Total 412 549.750000 22636.2500 7796.7000