CMS/EIP Fiscal Report Center: 54
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 47 24.500000 911.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 16.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 158 891.000000 33135.9000 37.1896
Subtotal (Total Children Is Unduplicated) 159 932.000000 34047.3000 36.5314
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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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 242.9400 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.000000 404.9000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 13.000000 778.9600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 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 8 14.500000 1174.2100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 21.500000 1741.0700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 52.500000 4251.4500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 33.500000 2712.8300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2429.4000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 931.2700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 57.000000 3415.4400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 48 92.000000 5512.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 64.500000 5223.2100 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 54.000000 4372.9200 80.9800
Subtotal (Total Children Is Unduplicated) 129 476.000000 35008.4000 73.5471
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 46 38.500000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 73 90.000000 1350.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 17.000000 204.0000 12.0000
TRAV-TRAVS-Travel by mile 50 926.000000 411.9600 0.4449
Subtotal (Total Children Is Unduplicated) 88 1071.500000 1965.9600 1.8348
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Total 2479.500000 71021.6600 28.6435
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Number of Children (Unduplicated) With at Least One Service 160
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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 367 453.750000 21248.0600 15210.1300
P 220 277.250000 12789.5900 12780.7500
D 16 13.750000 599.0600 0.0000
S 0 0.000000 0.0000 0.0000
H 7 10.500000 850.2900 0.0000
T 84 514.500000 3609.1400 3609.1400
636 1193.750000 31109.7600 0.0000
Other 11 14.750000 769.2600 0.0000
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Total 1343 2479.500000 71021.6600 31600.0200