CMS/EIP Fiscal Report Center: 10
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3128 9657.000000 357309.0000 37.0000
Subtotal (Total Children Is Unduplicated) 3128 9658.250000 357309.0000 36.9952
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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 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.500000 187.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 44.500000 3337.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 262 518.500000 38848.5000 74.9248
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 75 137.000000 10275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 14.500000 1087.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 110 195.000000 14586.0000 74.8000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 42.000000 2331.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 230 437.000000 24253.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.500000 787.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 98 171.500000 12862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 389 1597.500000 110316.0000 69.0554
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Total 11255.750000 467625.0000 41.5454
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Number of Children (Unduplicated) With at Least One Service 3128
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Center 10
Flag Claims Units Chgs Paid
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R 463 351.750000 13336.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2644 1923.000000 77757.7500 0.0000
P 6948 4858.000000 197789.0000 197265.8450
D 103 69.250000 2712.2500 0.0000
S 88 161.000000 11061.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5138 3858.000000 162643.0000 0.0000
Other 23 34.750000 2325.2500 0.0000
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Total 15407 11255.750000 467625.0000 197265.8450