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
Payclass Filters:GR
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 85 104.250000 3868.8000 37.1108
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19 19.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 125.000000 4613.8000 36.9104
Subtotal (Total Children Is Unduplicated) 96 249.000000 8482.6000 34.0667
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2109.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 36 94.000000 5880.0000 62.5532
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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 434.250000 14703.2900 33.8590
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Number of Children (Unduplicated) With at Least One Service 103
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Center 07
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 40 97.000000 1618.6900 1606.6900
D 2 4.000000 185.4000 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
413 334.250000 12911.2000 0.0000
Other 1 -1.000000 -12.0000 -12.0000
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Total 456 434.250000 14703.2900 1594.6900