CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 24.500000 1837.5000 75.0000
Subtotal (Total Children Is Unduplicated) 17 40.000000 2834.2500 70.8563
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 9.250000 462.5000 50.0000
TRAV-TRAVS-Travel by mile 20 1541.000000 685.7100 0.4450
Subtotal (Total Children Is Unduplicated) 21 1550.250000 1148.2100 0.7407
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Total 1590.250000 3982.4600 2.5043
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Number of Children (Unduplicated) With at Least One Service 27
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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 61 1590.250000 3982.4600 3840.0300
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 61 1590.250000 3982.4600 3840.0300