CMS/EIP Fiscal Report Center: 03
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 33 32.250000 1199.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 99 251.000000 9337.2000 37.2000
Subtotal (Total Children Is Unduplicated) 113 283.250000 10536.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.000000 1275.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 35.000000 1942.5000 55.5000
Subtotal (Total Children Is Unduplicated) 35 70.000000 4567.5000 65.2500
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 5.750000 402.5000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 5.000000 60.0000 12.0000
TRAV-TRAVS-Travel by mile 1 12.000000 5.3400 0.4450
Subtotal (Total Children Is Unduplicated) 5 22.750000 467.8400 20.5644
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Total 376.000000 15572.2400 41.4155
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Number of Children (Unduplicated) With at Least One Service 124
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Center 03
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 30 59.750000 3203.8400 3203.8400
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 108 119.750000 4784.1000 4784.1000
170 196.500000 7584.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 308 376.000000 15572.2400 7987.9400