CMS/EIP Fiscal Report Center: 52
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 25 10.750000 399.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 58 271.750000 10044.0000 36.9604
Subtotal (Total Children Is Unduplicated) 58 283.500000 10443.9000 36.8392
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 971.7600 80.9800
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 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 838.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 66.000000 5147.7200 77.9958
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1295.6800 80.9800
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 12 26.000000 1928.5200 74.1738
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 74.000000 4434.0800 59.9200
Subtotal (Total Children Is Unduplicated) 49 220.000000 15588.4000 70.8564
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 12 5.000000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 12 5.000000 0.0000 0.0000
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Total 508.500000 26032.3000 51.1943
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Number of Children (Unduplicated) With at Least One Service 58
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Center 52
Flag Claims Units Chgs Paid
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R 3 4.750000 264.2600 0.0000
U 0 0.000000 0.0000 0.0000
B 38 59.250000 2693.9800 0.0000
P 53 87.250000 4209.1200 4197.1600
D 3 6.000000 485.8800 0.0000
S 6 8.500000 316.2000 0.0000
H 6 12.000000 971.7600 0.0000
T 21 42.000000 3030.5600 2955.5600
225 288.750000 14060.5400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 355 508.500000 26032.3000 7152.7200