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
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
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 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 121 263.250000 9721.7500 36.9297
Subtotal (Total Children Is Unduplicated) 121 263.750000 9740.2500 36.9299
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 46.500000 3412.5000 73.3871
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 43.500000 3262.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 53 90.000000 4967.2500 55.1917
Subtotal (Total Children Is Unduplicated) 59 200.500000 12975.0000 64.7132
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Total 464.250000 22715.2500 48.9289
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Number of Children (Unduplicated) With at Least One Service 121
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 177 301.000000 16675.0000 0.0000
T 0 0.000000 0.0000 0.0000
167 163.250000 6040.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 344 464.250000 22715.2500 0.0000