CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 753 808.750000 29923.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 763 949.250000 35122.2500 37.0000
Subtotal (Total Children Is Unduplicated) 882 1758.000000 65046.0000 37.0000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 66.500000 4987.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 64.500000 4837.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 54 105.500000 5855.2500 55.5000
SCREEN-T1023-SCREENING 23 24.000000 1200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 90 277.000000 17936.7500 64.7536
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.750000 37.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 10 10.750000 537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.500000 37.5000 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 29 24.500000 1225.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 19 12.500000 625.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 35 26.000000 1300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 53 233.250000 11662.5000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 21 22.750000 841.7500 37.0000
Subtotal (Total Children Is Unduplicated) 92 333.000000 16316.7500 48.9992
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Total 2368.000000 99299.5000 41.9339
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Number of Children (Unduplicated) With at Least One Service 925
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Center 02
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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 4638 2368.000000 99299.5000 0.0000
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Total 4638 2368.000000 99299.5000 0.0000