CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 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 295 550.000000 20460.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 10.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 318 1632.750000 60691.8000 37.1715
Subtotal (Total Children Is Unduplicated) 329 2193.500000 81151.8000 36.9965
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 36.500000 2737.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 108 175.500000 13125.0000 74.7863
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 23.500000 1762.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 87 143.000000 10912.5000 76.3112
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 63 96.000000 7141.5000 74.3906
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.000000 1704.0000 56.8000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 201 331.000000 18370.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 38.500000 2887.5000 75.0000
Subtotal (Total Children Is Unduplicated) 300 951.000000 63948.0000 67.2429
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EI Services,Class #03
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 28 37.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 27 68.000000 1020.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 26 28.000000 336.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 26.000000 1870.9600 71.9600
TRAV-TRAVS-Travel by mile 10 826.000000 367.5000 0.4449
Subtotal (Total Children Is Unduplicated) 39 986.250000 3631.9600 3.6826
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Total 4130.750000 148731.7600 36.0060
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Number of Children (Unduplicated) With at Least One Service 339
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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 3 4.000000 148.8000 0.0000
P 1322 1470.370000 68784.7800 68299.9300
D 129 164.600000 10177.9500 0.0000
S 2 3.030000 227.0700 0.0000
H 0 0.000000 0.0000 0.0000
T 109 920.000000 4341.7500 4048.0400
2043 1568.750000 65051.4100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3608 4130.750000 148731.7600 72347.9700