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
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 47 25.000000 930.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 12.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 74 327.500000 12173.7000 37.1716
Subtotal (Total Children Is Unduplicated) 112 365.250000 13103.7000 35.8760
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 526.3700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.500000 607.3500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 15.000000 1214.7000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 958.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 34.000000 2079.4000 61.1588
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
Subtotal (Total Children Is Unduplicated) 35 110.000000 7896.9200 71.7902
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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 1112.750000 22415.7200 20.1444
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Number of Children (Unduplicated) With at Least One Service 130
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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 20 18.000000 669.6000 0.0000
S 5 7.000000 67.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 113 610.500000 4260.2500 4260.2500
479 475.250000 17344.2700 0.0000
Other 3 2.000000 74.4000 0.0000
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Total 620 1112.750000 22415.7200 4260.2500