CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 102 154.000000 5719.5000 37.1396
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 20.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 49 117.250000 4361.7000 37.2000
Subtotal (Total Children Is Unduplicated) 104 291.250000 10081.2000 34.6136
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.152800 386.4600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.518100 330.0000 73.0396
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 32.000000 1776.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 850.0000 70.8333
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 28 83.670900 5280.4600 63.1099
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 7 10.750000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 5 6.000000 90.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 25 31.000000 372.0000 12.0000
TRAV-TRAVS-Travel by mile 4 42.000000 18.6800 0.4448
Subtotal (Total Children Is Unduplicated) 33 89.750000 480.6800 5.3558
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Total 464.670900 15842.3400 34.0937
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Number of Children (Unduplicated) With at Least One Service 107
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Center 07
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 55 107.000000 2218.6800 2218.6800
D 3 1.750000 65.1000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
547 355.920900 13558.5600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 605 464.670900 15842.3400 2218.6800