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
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 38 45.500000 1692.6000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 28 20.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 296.000000 11011.2000 37.2000
Subtotal (Total Children Is Unduplicated) 96 362.250000 12703.8000 35.0692
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Screening, Eval, and Assessment,Class #02
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 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1162.5000 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 7 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 30 81.500000 5313.0000 65.1902
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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
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Total 873.500000 19116.8400 21.8853
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Number of Children (Unduplicated) With at Least One Service 117
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Center 54
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 4 7.000000 336.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 60 390.000000 2687.0400 2687.0400
459 476.500000 16093.8000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 523 873.500000 19116.8400 2687.0400