CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 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 71 110.250000 4101.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 30 118.000000 4389.6000 37.2000
Subtotal (Total Children Is Unduplicated) 81 232.250000 8490.9000 36.5593
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 10 26.500000 1753.5000 66.1698
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 8 11.000000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 10 20.000000 300.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 7.000000 84.0000 12.0000
TRAV-TRAVS-Travel by mile 6 304.000000 135.2500 0.4449
Subtotal (Total Children Is Unduplicated) 13 342.000000 519.2500 1.5183
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Total 600.750000 10763.6500 17.9170
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Number of Children (Unduplicated) With at Least One Service 84
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Center 53
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 4 2.000000 74.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 26 321.000000 650.5000 650.5000
378 277.750000 10038.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 408 600.750000 10763.6500 650.5000