CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 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 109 247.000000 9139.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 186 482.500000 17824.7500 36.9425
Subtotal (Total Children Is Unduplicated) 192 729.500000 26963.7500 36.9620
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 81 121.000000 8987.5000 74.2769
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 59 93.000000 6926.4700 74.4782
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 60 113.500000 8512.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 159 255.000000 14087.2500 55.2441
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
Subtotal (Total Children Is Unduplicated) 188 613.500000 40643.7200 66.2489
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EI Services,Class #03
INTR-T1013-INTERPRETER 10 35.000000 1750.0000 50.0000
Subtotal (Total Children Is Unduplicated) 10 35.000000 1750.0000 50.0000
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Total 1378.000000 69357.4700 50.3320
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Number of Children (Unduplicated) With at Least One Service 196
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Center 09
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 33 63.250000 2601.7500 0.0000
P 448 703.000000 32595.9700 33158.5800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 228 290.500000 16155.5000 0.0000
T 0 0.000000 0.0000 0.0000
142 203.250000 9377.5000 0.0000
Other 60 117.000000 8589.7500 0.0000
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Total 912 1378.000000 69357.4700 33158.5800