CMS/EIP Fiscal Report Center: 54
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 31 25.000000 930.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 6.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 144 802.750000 29853.0000 37.1884
Subtotal (Total Children Is Unduplicated) 145 834.250000 30783.0000 36.8990
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.000000 750.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 32 59.500000 4462.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 47.000000 3525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 56 109.000000 6049.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 21.500000 1612.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 69.000000 5175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 128 383.500000 26276.2500 68.5169
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EI Services,Class #03
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 20 15.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 21 26.000000 390.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 5.000000 60.0000 12.0000
TRAV-TRAVS-Travel by mile 9 91.000000 40.4900 0.4449
Subtotal (Total Children Is Unduplicated) 26 138.500000 540.4900 3.9025
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Total 1356.250000 57599.7400 42.4699
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Number of Children (Unduplicated) With at Least One Service 146
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Center 54
Flag Claims Units Chgs Paid
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R 6 5.750000 213.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 62 81.500000 3595.8000 0.0000
P 430 553.750000 25327.2000 25327.2000
D 13 23.250000 1185.0000 0.0000
S 1 1.500000 112.5000 0.0000
H 2 3.500000 223.5000 0.0000
T 40 137.500000 3273.9300 3273.9300
448 544.750000 23418.0100 0.0000
Other 3 4.750000 249.9000 0.0000
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Total 1005 1356.250000 57599.7400 28601.1300