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
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 81 121.000000 4501.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 4.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 192.750000 7151.7000 37.1035
Subtotal (Total Children Is Unduplicated) 99 318.250000 11652.9000 36.6156
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 15 41.500000 2722.5000 65.6024
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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
TRAV-TRAVS-Travel by mile 5 438.000000 194.8800 0.4449
Subtotal (Total Children Is Unduplicated) 22 516.750000 965.8800 1.8691
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Total 876.500000 15341.2800 17.5029
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Number of Children (Unduplicated) With at Least One Service 99
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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 6 6.250000 232.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 38 465.000000 1009.3800 826.6700
531 405.250000 14099.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 575 876.500000 15341.2800 826.6700