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
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 8 4.250000 158.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8 30.250000 1125.3000 37.2000
Subtotal (Total Children Is Unduplicated) 14 37.250000 1283.4000 34.4537
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 3 8.000000 626.7800 78.3475
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 5 4.000000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 6 6.000000 90.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 3.000000 36.0000 12.0000
TRAV-TRAVS-Travel by mile 4 48.000000 21.3500 0.4448
Subtotal (Total Children Is Unduplicated) 8 61.000000 147.3500 2.4156
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Total 106.250000 2057.5300 19.3650
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Number of Children (Unduplicated) With at Least One Service 17
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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 2 1.250000 46.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 46.000000 61.1300 61.1300
56 58.750000 1940.6000 0.0000
Other 1 0.250000 9.3000 0.0000
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Total 65 106.250000 2057.5300 61.1300