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
Payclass Filters:GR
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 44 133.000000 4911.7500 36.9305
Subtotal (Total Children Is Unduplicated) 109 380.000000 14050.7500 36.9757
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.500000 937.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 11.500000 862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 43.000000 3225.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 25.500000 1415.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 37 98.000000 6833.2500 69.7270
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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 513.000000 22634.0000 44.1209
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Number of Children (Unduplicated) With at Least One Service 116
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Center 09
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 243 331.250000 14703.2500 14703.2500
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
128 177.750000 7669.7500 0.0000
Other 2 4.000000 261.0000 0.0000
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Total 373 513.000000 22634.0000 14703.2500