CMS/EIP Fiscal Report Center: 09
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 102 187.500000 6975.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 165 456.750000 16991.1000 37.2000
Subtotal (Total Children Is Unduplicated) 170 644.250000 23966.1000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 21.000000 1575.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 65 111.500000 8362.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 63 118.500000 8848.5000 74.6709
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 21 39.500000 2962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 19.500000 1082.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 120 212.000000 11766.0000 55.5000
Subtotal (Total Children Is Unduplicated) 151 539.500000 35772.7500 66.3072
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EI Services,Class #03
INTR-T1013-INTERPRETER 10 17.250000 862.5000 50.0000
TRAV-TRAVS-Travel by mile 2 104.000000 45.7400 0.4398
Subtotal (Total Children Is Unduplicated) 12 121.250000 908.2400 7.4906
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Total 1305.000000 60647.0900 46.4729
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Number of Children (Unduplicated) With at Least One Service 171
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Center 09
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 455 695.500000 27492.8900 27492.8900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 340 524.500000 27130.2000 16368.1500
T 0 0.000000 0.0000 0.0000
18 35.000000 2547.0000 2547.0000
Other 26 50.000000 3477.0000 150.0000
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Total 839 1305.000000 60647.0900 46558.0400