CMS/EIP Fiscal Report Center: 52
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 35 18.000000 669.6000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 83 323.000000 11950.5000 36.9985
Subtotal (Total Children Is Unduplicated) 84 342.000000 12620.1000 36.9009
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 49 98.500000 7814.5700 79.3357
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 40.000000 3239.2000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 22.000000 1781.5600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 102.000000 6111.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
Subtotal (Total Children Is Unduplicated) 62 278.500000 20074.3700 72.0803
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 17 7.000000 0.0000 0.0000
TRAV-TRAVS-Travel by mile 1 11.000000 4.8900 0.4445
Subtotal (Total Children Is Unduplicated) 17 18.000000 4.8900 0.2717
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Total 638.500000 32699.3600 51.2128
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Number of Children (Unduplicated) With at Least One Service 84
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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 39 53.500000 2500.2800 0.0000
P 38 70.500000 4592.3600 4123.3600
D 4 8.000000 647.8400 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 809.8000 0.0000
T 41 91.000000 5672.4100 5627.4100
294 366.000000 17007.2700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 453 638.500000 32699.3600 9750.7700