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
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 81 44.000000 1636.8000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 51.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 53 222.000000 8258.4000 37.2000
Subtotal (Total Children Is Unduplicated) 94 317.500000 9895.2000 31.1660
-----------------------------------------------------------------------------------------------------------------------
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 11 20.000000 1619.6000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 14.500000 1174.2100 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 15 25.000000 1498.0000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1198.4000 59.9200
Subtotal (Total Children Is Unduplicated) 31 97.500000 6863.6100 70.3960
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 1838.000000 18004.0700 9.7955
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 97
-----------------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 158 1399.500000 7293.2500 7293.2500
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
476 438.500000 10710.8200 815.6200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 634 1838.000000 18004.0700 8108.8700