CMS/EIP Fiscal Report Center: 55
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 106 73.750000 2743.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 143 639.750000 23798.7000 37.2000
Subtotal (Total Children Is Unduplicated) 153 715.000000 26542.2000 37.1220
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1283.7200 80.2325
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 479.3600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 144.000000 11601.3200 80.5647
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 34.000000 2753.3200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1295.6800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 60.000000 4858.8000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 82.000000 4886.9200 59.5966
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 599.2000 59.9200
Subtotal (Total Children Is Unduplicated) 103 398.000000 30025.7600 75.4416
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Total 1113.000000 56567.9600 50.8248
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Number of Children (Unduplicated) With at Least One Service 153
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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 71 117.000000 5660.4800 0.0000
P 177 336.750000 20056.2200 19892.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 25.000000 2024.5000 0.0000
T 0 0.000000 0.0000 0.0000
572 634.250000 28826.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 833 1113.000000 56567.9600 19892.4200