CMS/EIP Fiscal Report Center: 51
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
Payclass Filters:GR
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 331 357.750000 13236.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 228 496.750000 18342.7500 36.9255
Subtotal (Total Children Is Unduplicated) 450 857.000000 31579.5000 36.8489
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 29 29.000000 1609.5000 55.5000
Subtotal (Total Children Is Unduplicated) 29 31.000000 1759.5000 56.7581
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 6.250000 312.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 3.750000 198.2100 52.8560
Subtotal (Total Children Is Unduplicated) 7 10.000000 510.7100 51.0710
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Total 898.000000 33849.7100 37.6946
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Number of Children (Unduplicated) With at Least One Service 454
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Center 51
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
1338 898.000000 33849.7100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1338 898.000000 33849.7100 0.0000