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
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 102 187.500000 6975.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 67 213.250000 7932.9000 37.2000
Subtotal (Total Children Is Unduplicated) 116 400.750000 14907.9000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1500.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 27.000000 1986.0000 73.5556
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 15.500000 1162.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 35.500000 1970.2500 55.5000
Subtotal (Total Children Is Unduplicated) 36 101.000000 6814.5000 67.4703
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 10 17.250000 862.5000 50.0000
TRAV-TRAVS-Travel by mile 1 52.000000 22.8700 0.4398
Subtotal (Total Children Is Unduplicated) 11 69.250000 885.3700 12.7851
-----------------------------------------------------------------------------------------------------------------------
Total 571.000000 22607.7700 39.5933
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 117
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 417 571.000000 22607.7700 22607.7700
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 417 571.000000 22607.7700 22607.7700