CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2025 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 109 54.750000 2036.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 83 82.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 138 592.250000 22031.7000 37.2000
Subtotal (Total Children Is Unduplicated) 138 729.500000 24068.4000 32.9930
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 37.500000 3036.7500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 31.000000 2510.3800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 12.000000 971.7600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.000000 728.8200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 35.500000 2127.1600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 31 53.500000 3205.7200 59.9200
Subtotal (Total Children Is Unduplicated) 58 187.500000 13309.4100 70.9835
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 20 23.000000 345.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 28 28.000000 336.0000 12.0000
TRAV-TRAVS-Travel by mile 74 1618.000000 719.9100 0.4449
Subtotal (Total Children Is Unduplicated) 74 1669.000000 1400.9100 0.8394
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Total 2586.000000 38778.7200 14.9956
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Number of Children (Unduplicated) With at Least One Service 138
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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 284 229.250000 8528.1000 7386.0600
P 232 1823.000000 14227.0700 14227.0700
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
732 533.250000 16004.9500 483.2500
Other 0 0.000000 0.0000 0.0000
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Total 1249 2586.000000 38778.7200 22096.3800