CMS/EIP Fiscal Report Center: 55
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 99 100.000000 3720.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7 8.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 135 764.500000 28430.1000 37.1878
Subtotal (Total Children Is Unduplicated) 137 873.250000 32150.1000 36.8166
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 93 188.000000 15224.2400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.000000 2510.3800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 20.000000 1619.6000 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 21 42.000000 3401.1600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 92.000000 5512.6400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 958.7200 59.9200
Subtotal (Total Children Is Unduplicated) 119 411.000000 30881.9400 75.1385
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Total 1284.250000 63032.0400 49.0808
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Number of Children (Unduplicated) With at Least One Service 139
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Center 55
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 243 472.750000 24235.2600 0.0000
P 20 40.000000 3070.7200 3070.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 18.000000 1415.5200 0.0000
T 0 0.000000 0.0000 0.0000
675 753.500000 34310.5400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 947 1284.250000 63032.0400 3070.7200