CMS/EIP Fiscal Report Center: 55
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 103 229.250000 8482.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 108 500.750000 18481.5000 36.9076
Subtotal (Total Children Is Unduplicated) 109 731.750000 26963.7500 36.8483
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.829867 212.2400 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 91 180.836800 13562.7600 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000001 2400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 36 73.000000 5475.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 3885.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.333333 100.0000 75.0000
Subtotal (Total Children Is Unduplicated) 101 387.000001 27518.0000 71.1059
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EI Services,Class #03
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 120.0000 60.0000
Subtotal (Total Children Is Unduplicated) 2 3.000000 170.0000 56.6667
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Total 1121.750001 54651.7500 48.7201
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Number of Children (Unduplicated) With at Least One Service 109
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Center 55
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 361 464.500000 22516.2500 0.0000
P 140 137.250000 6784.2500 6784.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
494 504.000001 24151.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1003 1121.750001 54651.7500 6784.2500