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
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 103 229.250000 8482.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 27 110.250000 4079.2500 37.0000
Subtotal (Total Children Is Unduplicated) 105 341.250000 12561.5000 36.8103
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.170133 537.7600 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.955335 521.6500 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.333333 100.0000 75.0000
Subtotal (Total Children Is Unduplicated) 13 28.458801 1914.4100 67.2695
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.000000 120.0000 60.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 120.0000 60.0000
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Total 371.708801 14595.9100 39.2671
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Number of Children (Unduplicated) With at Least One Service 105
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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 0 0.000000 0.0000 0.0000
P 3 4.250000 309.2500 309.2500
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
421 367.458801 14286.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 424 371.708801 14595.9100 309.2500