CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/10/2023 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 96 154.000000 5728.8000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 113 432.750000 16014.6000 37.0066
Subtotal (Total Children Is Unduplicated) 116 588.250000 21743.4000 36.9629
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 34 57.500000 4312.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 26 43.000000 3225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 24.000000 1800.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 63 96.500000 5355.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 15.500000 1162.5000 75.0000
Subtotal (Total Children Is Unduplicated) 99 248.000000 16611.0000 66.9798
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
Subtotal (Total Children Is Unduplicated) 1 1.500000 15.0000 10.0000
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Total 837.750000 38369.4000 45.8005
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Number of Children (Unduplicated) With at Least One Service 119
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Center 53
Flag Claims Units Chgs Paid
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R 13 13.750000 738.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 60 67.250000 3307.2000 0.0000
P 296 313.750000 14361.1500 14361.1500
D 12 16.500000 977.2500 0.0000
S 2 2.250000 140.4000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 8.500000 471.7500 416.2500
519 402.000000 17616.1500 0.0000
Other 13 13.750000 757.2000 0.0000
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Total 922 837.750000 38369.4000 14777.4000