CMS/EIP Fiscal Report Center: 55
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 418 382.750000 14238.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 34.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 523 3287.500000 122276.4000 37.1943
Subtotal (Total Children Is Unduplicated) 526 3704.750000 136514.7000 36.8486
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 62.000000 4889.2000 78.8581
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 623.9200 77.9900
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 461.9600 76.9933
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 20.000000 1559.8000 77.9900
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2112.9200 58.6922
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
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 385 780.000000 61872.7200 79.3240
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 61 123.000000 9828.9800 79.9104
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 148.000000 11745.8400 79.3638
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 15 30.000000 2405.4800 80.1827
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 103 206.000000 16490.5200 80.0511
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1571.7600 78.5880
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 189 380.000000 22239.2000 58.5242
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 41 82.000000 4860.4000 59.2732
Subtotal (Total Children Is Unduplicated) 492 1905.000000 140944.5000 73.9866
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
TRAV-TRAVS-Travel by mile 1 70.000000 31.1500 0.4450
Subtotal (Total Children Is Unduplicated) 1 71.000000 46.1500 0.6500
-----------------------------------------------------------------------------------------------------------------------
Total 5680.750000 277505.3500 48.8501
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 526
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 541 1099.250000 56157.5800 0.0000
P 591 1160.054266 63220.0100 63044.2500
D 3 5.500000 292.1600 0.0000
S 0 0.000000 0.0000 0.0000
H 63 125.000000 9846.9000 0.0000
T 8 16.000000 1295.6800 1295.6800
3013 3274.945734 146693.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4219 5680.750000 277505.3500 64339.9300