CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2025 ending 03/31/2025 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 81 44.000000 1636.8000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 51.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 109 465.000000 17298.0000 37.2000
Subtotal (Total Children Is Unduplicated) 109 560.500000 18934.8000 33.7820
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.000000 1781.5600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 23.000000 1862.5400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 30.500000 1827.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 23.500000 1408.1200 59.9200
Subtotal (Total Children Is Unduplicated) 36 117.000000 8253.1800 70.5400
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 20 23.000000 345.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 24 24.000000 288.0000 12.0000
TRAV-TRAVS-Travel by mile 58 1376.000000 612.2600 0.4450
Subtotal (Total Children Is Unduplicated) 59 1423.000000 1245.2600 0.8751
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Total 2100.500000 28433.2400 13.5364
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Number of Children (Unduplicated) With at Least One Service 109
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Center 05
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 228 197.250000 7337.7000 5952.0000
P 165 1411.000000 8161.3400 8161.3400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
517 481.250000 12525.0000 1337.1000
Other 18 11.000000 409.2000 0.0000
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Total 928 2100.500000 28433.2400 15450.4400