CMS/EIP Fiscal Report Center: 54
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 29 21.750000 809.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 22 20.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 138 768.250000 28523.1000 37.1274
Subtotal (Total Children Is Unduplicated) 138 810.250000 29332.2000 36.2014
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 5.000000 404.9000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 7.000000 566.8600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 17.000000 1018.6400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.500000 1093.2300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.000000 1376.6600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 41.500000 3320.1800 80.0043
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 45.000000 3644.1000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 28.000000 2267.4400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 65.500000 3924.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 50 100.000000 5992.0000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 31.000000 2510.3800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1336.1700 80.9800
Subtotal (Total Children Is Unduplicated) 119 406.500000 28950.1900 71.2182
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 53 49.250000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 54 68.000000 1035.0000 15.2206
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 18 28.000000 336.0000 12.0000
TRAV-TRAVS-Travel by mile 30 671.000000 298.4900 0.4448
Subtotal (Total Children Is Unduplicated) 74 816.250000 1669.4900 2.0453
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Total 2033.000000 59951.8800 29.4894
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Number of Children (Unduplicated) With at Least One Service 138
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Center 54
Flag Claims Units Chgs Paid
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R 13 14.750000 617.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 165 219.500000 10386.2500 0.0000
P 244 303.500000 13958.7800 13850.8800
D 5 8.500000 491.3200 0.0000
S 24 28.500000 1023.0000 0.0000
H 4 7.000000 393.4000 0.0000
T 20 60.000000 1053.1100 853.9500
651 1374.750000 31106.4400 0.0000
Other 14 16.500000 921.9200 0.0000
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Total 1140 2033.000000 59951.8800 14704.8300