CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 27 13.750000 511.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 226 862.750000 32085.0000 37.1892
Subtotal (Total Children Is Unduplicated) 228 876.500000 32596.5000 37.1894
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 20.000000 1535.8800 76.7940
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 18.000000 1236.9400 68.7189
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.500000 712.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 7.000000 536.9600 76.7086
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 17.500000 1366.3200 78.0754
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 14.500000 1096.4700 75.6186
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 94.500000 5313.2600 56.2250
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 28 41.000000 2319.7000 56.5780
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 71.000000 5411.7100 76.2213
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 55.000000 4190.7800 76.1960
Subtotal (Total Children Is Unduplicated) 153 360.500000 24537.9000 68.0663
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
INTR-T1013-INTERPRETER 23 40.500000 2071.4000 51.1457
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 13.000000 156.0000 12.0000
TRAV-TRAVS-Travel by mile 17 460.000000 201.4100 0.4378
Subtotal (Total Children Is Unduplicated) 37 523.500000 2928.8100 5.5947
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Total 1760.500000 60063.2100 34.1171
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Number of Children (Unduplicated) With at Least One Service 229
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Center 01
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 119 582.000000 7556.7300 7556.7300
D 3 17.500000 239.0800 0.0000
S 2 1.750000 102.9000 0.0000
H 843 780.500000 36822.9600 31185.6800
T 0 0.000000 0.0000 0.0000
439 371.250000 15062.5400 0.0000
Other 13 7.500000 279.0000 0.0000
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Total 1419 1760.500000 60063.2100 38742.4100