CMS/EIP Fiscal Report Center: 05
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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 401 232.000000 8630.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 288 268.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 450 2474.500000 92051.4000 37.2000
Subtotal (Total Children Is Unduplicated) 450 2974.750000 100681.8000 33.8455
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.000000 1007.8900 77.5300
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 271.4700 77.5629
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 320.7200 58.3127
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.000000 523.8100 58.2011
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 118.500000 9421.1500 79.5034
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 57 94.500000 7484.9200 79.2055
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 467.9400 77.9900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 23 35.500000 2856.8500 80.4746
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 47.500000 3729.9400 78.5251
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 10.000000 785.8800 78.5880
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 86 142.500000 8401.4800 58.9578
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 89 148.500000 8741.2100 58.8634
Subtotal (Total Children Is Unduplicated) 201 642.500000 44674.6800 69.5326
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 22.000000 1128.0000 51.2727
EPIC-99601-Early Steps Professional Development Fee 92 140.000000 2100.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 125 137.000000 1644.0000 12.0000
TRAV-TRAVS-Travel by mile 281 6945.000000 3090.0000 0.4449
Subtotal (Total Children Is Unduplicated) 287 7248.000000 8162.0000 1.1261
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Total 10865.250000 153518.4800 14.1293
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Number of Children (Unduplicated) With at Least One Service 450
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Center 05
Flag Claims Units Chgs Paid
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R 1 0.500000 18.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 1213 1001.500000 37255.8000 34941.9900
P 1037 7855.500000 52240.9300 52240.9300
D 6 5.000000 186.0000 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
2817 1924.000000 60887.6500 595.7500
Other 92 78.750000 2929.5000 2929.5000
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Total 5166 10865.250000 153518.4800 90708.1700