CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 38 45.500000 1692.6000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 28 20.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 145 777.000000 28904.4000 37.2000
Subtotal (Total Children Is Unduplicated) 145 843.250000 30597.0000 36.2846
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 22.000000 1229.8400 55.9018
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 21.500000 1612.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 23.500000 1762.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 23 42.000000 3150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 22 44.500000 3349.4600 75.2688
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 35.500000 1979.0900 55.7490
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 111.500000 6194.8800 55.5595
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2700.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 13.500000 985.4600 72.9970
Subtotal (Total Children Is Unduplicated) 100 380.500000 25251.2300 66.3633
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 37 29.750000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 43 57.000000 855.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 8.000000 96.0000 12.0000
TRAV-TRAVS-Travel by mile 21 335.000000 149.0400 0.4449
Subtotal (Total Children Is Unduplicated) 48 429.750000 1100.0400 2.5597
-----------------------------------------------------------------------------------------------------------------------
Total 1653.500000 56948.2700 34.4410
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 145
-----------------------------------------------------------------------------------------------------------------------
Center 54
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 517 616.480000 27410.7000 27361.9500
D 18 31.420000 2179.4600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 76 420.500000 4496.7900 4496.7900
514 582.000000 22628.8200 0.0000
Other 2 3.100000 232.5000 71.2500
---------------------------------------------------------
Total 1127 1653.500000 56948.2700 31929.9900