CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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 83 214.250000 7927.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 118 324.000000 11941.7500 36.8573
Subtotal (Total Children Is Unduplicated) 125 538.250000 19869.0000 36.9141
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 11.500000 457.8800 39.8157
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 56 93.500000 6967.5000 74.5187
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 29 53.500000 4012.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 36 70.500000 5287.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 90 158.000000 8669.0000 54.8671
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.000000 1650.0000 75.0000
Subtotal (Total Children Is Unduplicated) 119 427.500000 28431.8800 66.5073
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.500000 125.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 2.500000 125.0000 50.0000
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Total 968.250000 48425.8800 50.0138
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Number of Children (Unduplicated) With at Least One Service 126
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Center 09
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 31 54.250000 2044.2500 0.0000
P 266 422.500000 19468.1300 19520.1300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 93 131.000000 7323.7500 0.0000
T 128 184.750000 7969.5000 7548.0000
40 73.250000 4225.2500 0.0000
Other 54 102.500000 7395.0000 0.0000
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Total 612 968.250000 48425.8800 27068.1300