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
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 92 43.750000 1627.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 67 51.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 53 240.500000 8946.6000 37.2000
Subtotal (Total Children Is Unduplicated) 101 336.000000 10574.1000 31.4705
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 736.4200 77.5179
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 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 1 1.500000 112.5000 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 9 17.500000 1324.4600 75.6834
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 508.4300 78.2200
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.500000 721.4700 75.9442
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 22.000000 1262.9900 57.4086
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1127.6800 56.3840
Subtotal (Total Children Is Unduplicated) 36 115.500000 7782.7900 67.3835
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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 28 62.000000 930.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 37 47.000000 564.0000 12.0000
TRAV-TRAVS-Travel by mile 73 1834.000000 815.8900 0.4449
Subtotal (Total Children Is Unduplicated) 76 1969.000000 3637.8900 1.8476
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Total 2420.500000 21994.7800 9.0869
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Number of Children (Unduplicated) With at Least One Service 103
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Center 05
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 0 0.000000 0.0000 0.0000
P 321 2084.500000 11420.6800 11420.6800
D 0 0.000000 0.0000 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
533 336.000000 10574.1000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 854 2420.500000 21994.7800 11420.6800