CMS/EIP Fiscal Report Center: 04
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 842 970.000000 35890.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1539 7303.750000 270223.7500 36.9979
Subtotal (Total Children Is Unduplicated) 1575 8273.750000 306113.7500 36.9982
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 42 64.000000 3200.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 10.000000 750.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 18 19.000000 1425.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 22 37.000000 2775.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 38 77.500000 4301.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 34 38.000000 2850.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 56 59.000000 4425.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 120 238.500000 13236.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 68 90.500000 6787.5000 75.0000
Subtotal (Total Children Is Unduplicated) 209 633.500000 39750.5000 62.7474
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Total 8907.250000 345864.2500 38.8295
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Number of Children (Unduplicated) With at Least One Service 1575
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Center 04
Flag Claims Units Chgs Paid
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R 330 497.000000 18389.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2906 4249.000000 157198.0000 0.0000
P 528 688.250000 25465.2500 25420.8500
D 3 5.500000 203.5000 0.0000
S 2 2.500000 92.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3574 3463.500000 144460.5000 0.0000
Other 1 1.500000 55.5000 0.0000
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Total 7344 8907.250000 345864.2500 25420.8500