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
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 295 550.000000 20460.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 10.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 142 612.750000 22775.7000 37.1696
Subtotal (Total Children Is Unduplicated) 309 1173.500000 43235.7000 36.8434
-----------------------------------------------------------------------------------------------------------------------
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 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 19.000000 1425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 10.500000 758.2500 72.2143
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 38 61.000000 3385.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 58 150.500000 9854.2500 65.4767
-----------------------------------------------------------------------------------------------------------------------
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
TRAV-TRAVS-Travel by mile 10 826.000000 367.5000 0.4449
Subtotal (Total Children Is Unduplicated) 39 960.250000 1761.0000 1.8339
-----------------------------------------------------------------------------------------------------------------------
Total 2284.250000 54850.9500 24.0127
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 313
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 55 49.500000 2179.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 97 901.500000 3139.5000 2956.7900
1886 1333.250000 49532.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2038 2284.250000 54850.9500 2956.7900