CMS/EIP Fiscal Report Center: 52
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 115 57.250000 2120.4000 37.0376
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 226 1060.000000 39301.8000 37.0772
Subtotal (Total Children Is Unduplicated) 227 1119.750000 41422.2000 36.9924
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Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 32.000000 2369.6000 74.0500
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 773.9200 77.3920
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 311.9600 77.9900
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1291.7200 58.7145
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 158 328.500000 24862.0900 75.6837
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.500000 1234.2600 79.6297
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 104.000000 8278.4000 79.6000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 11.000000 860.8800 78.2618
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 70.000000 5437.8200 77.6831
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 168 333.500000 19645.1900 58.9061
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 203 946.500000 66136.3600 69.8747
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 63 31.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
TRAV-TRAVS-Travel by mile 10 146.000000 64.9600 0.4449
Subtotal (Total Children Is Unduplicated) 69 179.500000 129.9600 0.7240
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Total 2245.750000 107688.5200 47.9521
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Number of Children (Unduplicated) With at Least One Service 228
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Center 52
Flag Claims Units Chgs Paid
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R 32 39.500000 1469.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 91 127.000000 5624.6400 0.0000
P 265 410.500000 22023.5400 20723.1800
D 28 54.750000 4231.2000 0.0000
S 27 30.500000 1180.0400 111.0000
H 21 40.250000 2943.7000 0.0000
T 150 408.500000 19582.4600 19247.3600
955 1132.750000 50483.5400 0.0000
Other 1 2.000000 150.0000 150.0000
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Total 1570 2245.750000 107688.5200 40231.5400