CMS/EIP Fiscal Report Center: 07
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 71 119.500000 4454.7000 37.2778
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 19.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 30 111.000000 4129.2000 37.2000
Subtotal (Total Children Is Unduplicated) 71 249.750000 8583.9000 34.3700
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
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 2 4.000000 223.9200 55.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1677.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
Subtotal (Total Children Is Unduplicated) 25 62.000000 3909.8800 63.0626
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 14 23.000000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 3 3.000000 45.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9 10.000000 120.0000 12.0000
TRAV-TRAVS-Travel by mile 3 30.000000 13.3500 0.4450
Subtotal (Total Children Is Unduplicated) 24 66.000000 178.3500 2.7023
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Total 377.750000 12672.1300 33.5463
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Number of Children (Unduplicated) With at Least One Service 73
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Center 07
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 21 53.000000 803.9100 803.9100
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
406 324.750000 11868.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 427 377.750000 12672.1300 803.9100