CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 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 47 25.000000 930.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 12.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 166 779.250000 28978.8000 37.1881
Subtotal (Total Children Is Unduplicated) 166 817.000000 29908.8000 36.6081
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 19.000000 1538.6200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.500000 1255.1900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 32.000000 2567.4400 80.2325
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 46.000000 3725.0800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1619.6000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 17 30.500000 2469.8900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 49.500000 2966.0400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 66 127.500000 7681.9200 60.2504
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 30.000000 2429.4000 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1579.1100 80.9800
Subtotal (Total Children Is Unduplicated) 111 413.000000 29482.6000 71.3864
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 39 32.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 50 70.000000 1050.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10 11.000000 132.0000 12.0000
TRAV-TRAVS-Travel by mile 42 524.000000 233.1000 0.4448
Subtotal (Total Children Is Unduplicated) 61 637.500000 1415.1000 2.2198
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Total 1867.500000 60806.5000 32.5604
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Number of Children (Unduplicated) With at Least One Service 168
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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 17 17.250000 729.2600 0.0000
P 466 546.500000 24544.7900 24532.8300
D 30 36.000000 2073.1600 0.0000
S 5 7.000000 67.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 129 639.500000 5997.9300 5997.9300
545 602.250000 26007.1100 0.0000
Other 13 19.000000 1387.0500 112.5000
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Total 1205 1867.500000 60806.5000 30643.2600