CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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
CASE-CASE-NON-TCM CASE MANAGEMENT 1501 2174.750000 80282.7500 36.9159
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 70 78.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1448 3730.750000 137871.7500 36.9555
Subtotal (Total Children Is Unduplicated) 1702 5983.500000 218154.5000 36.4593
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 28 33.500000 1675.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 112.000000 8400.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 48.000000 3600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 58.000000 4350.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 126 252.000000 13986.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 83.000000 4606.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 104 217.500000 16312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 83.500000 6262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 305 905.500000 60386.5000 66.6886
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 53 81.500000 0.0000 0.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 54 83.500000 100.0000 1.1976
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Total 6972.500000 278641.0000 39.9629
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Number of Children (Unduplicated) With at Least One Service 1714
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Center 07
Flag Claims Units Chgs Paid
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R 14 20.500000 1366.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 696 558.750000 22017.2500 0.0000
P 2898 2393.250000 102532.0000 102406.2000
D 18 18.500000 988.5000 0.0000
S 1 1.000000 50.0000 0.0000
H 40 79.500000 5905.5000 0.0000
T 0 0.000000 0.0000 0.0000
7228 3901.000000 145781.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10895 6972.500000 278641.0000 102406.2000