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
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 45 51.750000 1925.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 22 16.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 52 306.500000 11401.8000 37.2000
Subtotal (Total Children Is Unduplicated) 96 375.000000 13326.9000 35.5384
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 5.000000 404.9000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 7.000000 566.8600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.000000 410.6000 58.6571
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.500000 598.3800 79.7840
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 12.000000 911.9600 75.9967
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 692.9400 76.9933
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 235.2600 58.8150
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 26.000000 1460.6800 56.1800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 434.9200 72.4867
Subtotal (Total Children Is Unduplicated) 31 95.000000 6518.6800 68.6177
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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 50 43.750000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 56 72.000000 1080.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11 16.000000 192.0000 12.0000
TRAV-TRAVS-Travel by mile 33 411.000000 182.8400 0.4449
Subtotal (Total Children Is Unduplicated) 67 544.750000 1554.8400 2.8542
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Total 1014.750000 21400.4200 21.0894
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Number of Children (Unduplicated) With at Least One Service 119
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Center 54
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 0 0.000000 0.0000 0.0000
D 10 8.250000 306.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 84 474.000000 2900.7000 2900.7000
511 532.250000 18183.5200 0.0000
Other 1 0.250000 9.3000 0.0000
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Total 606 1014.750000 21400.4200 2900.7000