CMS/EIP Fiscal Report Center: 55
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 134 100.750000 3747.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 179 875.000000 32550.0000 37.2000
Subtotal (Total Children Is Unduplicated) 188 978.750000 36297.9000 37.0860
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 20.000000 1500.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 98 204.000000 15300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 42.000000 3150.0000 75.0000
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 15 30.000000 2250.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 761.9600 76.1960
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 58 116.000000 6438.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
Subtotal (Total Children Is Unduplicated) 127 494.000000 34331.9600 69.4979
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
TRAV-TRAVS-Travel by mile 1 70.000000 31.1500 0.4450
Subtotal (Total Children Is Unduplicated) 1 71.000000 46.1500 0.6500
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Total 1543.750000 70676.0100 45.7820
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Number of Children (Unduplicated) With at Least One Service 188
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Center 55
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 8 15.250000 603.9000 0.0000
P 324 655.804266 30634.4700 30634.4700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16 32.000000 2400.0000 0.0000
T 0 0.000000 0.0000 0.0000
834 840.695734 37037.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1182 1543.750000 70676.0100 30634.4700