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
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 566 354.750000 13125.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 299 250.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1740 7455.250000 275844.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1759 8060.500000 288970.0000 35.8501
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 125 140.250000 7012.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 19.500000 1462.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 5.000000 375.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 23.000000 1276.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 194 218.000000 16350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 8.500000 637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 95 105.500000 7912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 283 349.000000 19369.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 8.500000 637.5000 75.0000
Subtotal (Total Children Is Unduplicated) 435 878.750000 55146.0000 62.7551
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Total 8939.250000 344116.0000 38.4950
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Number of Children (Unduplicated) With at Least One Service 1759
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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 341 339.750000 14367.2500 18.5000
P 4394 4517.000000 177404.5000 175257.7220
D 14 7.000000 259.0000 0.0000
S 1 3.000000 111.0000 111.0000
H 16 15.750000 611.5000 75.0000
T 0 0.000000 0.0000 0.0000
4561 4056.000000 151335.0000 0.0000
Other 1 0.750000 27.7500 27.7500
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Total 9328 8939.250000 344116.0000 175489.9720