CMS/EIP Fiscal Report Center: 06
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 79 39.750000 1478.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 140 635.750000 23649.9000 37.2000
Subtotal (Total Children Is Unduplicated) 142 678.500000 25128.6000 37.0355
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 39.500000 2925.0000 74.0506
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 49.000000 3675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 51.500000 3862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 52.500000 3937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 19.000000 1387.5000 73.0263
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 24.000000 1800.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 35.000000 1971.7500 56.3357
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 44.500000 2469.7500 55.5000
Subtotal (Total Children Is Unduplicated) 107 317.000000 22159.5000 69.9038
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EI Services,Class #03
INTR-T1013-INTERPRETER 5 12.000000 1000.0000 83.3333
Subtotal (Total Children Is Unduplicated) 5 12.000000 1000.0000 83.3333
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Total 1007.500000 48288.1000 47.9286
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Number of Children (Unduplicated) With at Least One Service 143
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Center 06
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 6 12.000000 1000.0000 1000.0000
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 0 0.000000 0.0000 0.0000
922 989.000000 47046.3000 0.0000
Other 5 6.500000 241.8000 0.0000
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Total 933 1007.500000 48288.1000 1000.0000