CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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 15 5.500000 203.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 45 183.500000 6789.5000 37.0000
Subtotal (Total Children Is Unduplicated) 53 189.000000 6993.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 100.6600 67.1067
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.000000 1050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 14.500000 1087.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 15.500000 860.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 12.500000 937.5000 75.0000
Subtotal (Total Children Is Unduplicated) 23 67.500000 4660.6600 69.0468
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EI Services,Class #03
INTR-T1013-INTERPRETER 14 19.750000 987.5000 50.0000
TRAV-TRAVS-Travel by mile 1 19.000000 8.4500 0.4447
Subtotal (Total Children Is Unduplicated) 15 38.750000 995.9500 25.7019
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Total 295.250000 12649.6100 42.8437
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Number of Children (Unduplicated) With at Least One Service 63
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Center 01
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 14 20.750000 1245.7500 1245.7500
D 3 2.750000 163.1600 0.0000
S 2 1.000000 37.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 11 33.250000 808.2000 808.2000
299 236.750000 10367.7500 0.0000
Other 3 0.750000 27.7500 0.0000
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Total 332 295.250000 12649.6100 2053.9500