CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2024 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 81 121.000000 4501.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 4.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 102 470.750000 17465.4000 37.1012
Subtotal (Total Children Is Unduplicated) 106 596.250000 21966.6000 36.8413
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 21.500000 1612.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 24.000000 1762.5000 73.4375
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 26 44.000000 3300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 29.000000 2175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.000000 1038.0000 57.6667
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 43 70.500000 3912.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
Subtotal (Total Children Is Unduplicated) 77 254.000000 17218.5000 67.7894
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 16 23.750000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 16 37.000000 555.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 16 18.000000 216.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 11.000000 791.5600 71.9600
TRAV-TRAVS-Travel by mile 5 438.000000 194.8800 0.4449
Subtotal (Total Children Is Unduplicated) 22 527.750000 1757.4400 3.3301
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Total 1378.000000 40942.5400 29.7116
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Number of Children (Unduplicated) With at Least One Service 107
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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 357 382.970000 17585.8800 17473.3800
D 33 49.250000 3252.7500 0.0000
S 2 3.030000 227.0700 0.0000
H 0 0.000000 0.0000 0.0000
T 39 467.000000 1120.3800 826.6700
577 471.750000 18607.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1011 1378.000000 40942.5400 18300.0500