CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.000000 975.0000 75.0000
Subtotal (Total Children Is Unduplicated) 14 39.000000 2808.0000 72.0000
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 6.750000 337.5000 50.0000
TRAV-TRAVS-Travel by mile 24 1291.000000 574.4300 0.4449
Subtotal (Total Children Is Unduplicated) 24 1297.750000 911.9300 0.7027
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Total 1336.750000 3719.9300 2.7828
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Number of Children (Unduplicated) With at Least One Service 28
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Center 02
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 63 1336.750000 3719.9300 3719.9200
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 63 1336.750000 3719.9300 3719.9200