CMS/EIP Fiscal Report Center: 54
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 166 120.500000 4482.6000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 76 68.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 467 3254.500000 120983.7000 37.1743
Subtotal (Total Children Is Unduplicated) 467 3443.500000 125466.3000 36.4357
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 9.000000 728.8200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 16.000000 1283.7200 80.2325
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 16.000000 1295.6800 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.000000 1007.8900 77.5300
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 607.3500 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.000000 1004.9000 77.3000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 16.000000 958.7200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 28 58.000000 3395.8000 58.5483
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 647.8400 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 57.000000 4576.9900 80.2981
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 39 74.500000 5904.4400 79.2542
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 146.000000 11891.2300 81.4468
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 86 159.500000 12665.1500 79.4053
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 35 68.500000 5508.2600 80.4126
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 64 122.500000 9677.8600 79.0029
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 108 218.000000 12932.1700 59.3219
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 227 442.500000 26061.6800 58.8965
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 87 171.500000 13660.8300 79.6550
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 105.000000 8395.1300 79.9536
Subtotal (Total Children Is Unduplicated) 441 1723.500000 122366.4200 70.9988
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 0.500000 25.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 169 147.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 221 298.000000 4485.0000 15.0503
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 48 68.000000 816.0000 12.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 152 2678.000000 1191.3600 0.4449
Subtotal (Total Children Is Unduplicated) 270 3197.500000 6880.2000 2.1517
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Total 8364.500000 254712.9200 30.4517
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Number of Children (Unduplicated) With at Least One Service 468
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Center 54
Flag Claims Units Chgs Paid
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R 2 1.250000 46.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 395 482.250000 22570.9400 15377.5300
P 1663 1987.130000 90767.0400 90626.3900
D 112 123.920000 7211.0700 0.0000
S 5 7.000000 30.0000 0.0000
H 8 12.500000 1012.2500 0.0000
T 457 2636.500000 22151.0000 22151.0000
2342 3063.500000 108183.1600 0.0000
Other 41 50.450000 2740.9600 182.2500
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Total 5025 8364.500000 254712.9200 128337.1700