CMS/EIP Fiscal Report Center: 52
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 23 12.750000 465.0000 36.4706
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 37 155.750000 5831.1000 37.4388
Subtotal (Total Children Is Unduplicated) 51 169.500000 6296.1000 37.1451
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 24.000000 1332.0000 55.5000
Subtotal (Total Children Is Unduplicated) 14 38.000000 2304.0000 60.6316
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 13 9.250000 0.0000 0.0000
TRAV-TRAVS-Travel by mile 4 50.000000 22.2500 0.4450
Subtotal (Total Children Is Unduplicated) 16 59.250000 22.2500 0.3755
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Total 266.750000 8622.3500 32.3237
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Number of Children (Unduplicated) With at Least One Service 52
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Center 52
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 58.000000 544.2500 529.4500
198 208.750000 8078.1000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 206 266.750000 8622.3500 529.4500