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
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 29 21.750000 809.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 22 20.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 57 320.500000 11885.4000 37.0839
Subtotal (Total Children Is Unduplicated) 86 362.500000 12694.5000 35.0193
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 5.000000 404.9000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 3.000000 242.9400 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 3 5.000000 299.6000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 728.8200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.000000 728.8200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1318.2400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 35.000000 2097.2000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 971.7600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
Subtotal (Total Children Is Unduplicated) 48 126.000000 8813.5200 69.9486
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 1304.750000 23177.5100 17.7639
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 113
-----------------------------------------------------------------------------------------------------------------------
Center 54
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 0 0.000000 0.0000 0.0000
D 5 8.500000 491.3200 0.0000
S 1 1.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 14 52.000000 554.3500 554.3500
581 1243.250000 22131.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 601 1304.750000 23177.5100 554.3500