CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 86 104.750000 3887.4000 37.1112
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19 19.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 87 247.500000 9170.8000 37.0537
Subtotal (Total Children Is Unduplicated) 100 372.000000 13058.2000 35.1027
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 30.000000 2250.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 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 39 78.000000 4329.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 32.000000 1776.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 24.000000 1800.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 73 218.000000 14010.0000 64.2661
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 13 15.250000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 6 6.000000 90.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 17 19.000000 228.0000 12.0000
TRAV-TRAVS-Travel by mile 5 51.000000 22.6900 0.4449
Subtotal (Total Children Is Unduplicated) 30 91.250000 340.6900 3.7336
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Total 681.250000 27408.8900 40.2332
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Number of Children (Unduplicated) With at Least One Service 109
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Center 07
Flag Claims Units Chgs Paid
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R 1 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 45.000000 2161.8000 0.0000
P 152 249.000000 9131.8900 9119.8900
D 7 14.000000 935.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
428 359.750000 14615.8000 0.0000
Other 19 11.500000 453.0000 -12.0000
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Total 647 681.250000 27408.8900 9107.8900