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
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 79 39.750000 1478.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 79 362.500000 13485.0000 37.2000
Subtotal (Total Children Is Unduplicated) 112 405.250000 14963.7000 36.9246
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
Subtotal (Total Children Is Unduplicated) 5 18.000000 1242.7500 69.0417
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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 435.250000 17206.4500 39.5323
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Number of Children (Unduplicated) With at Least One Service 115
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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
472 416.750000 15964.6500 0.0000
Other 5 6.500000 241.8000 0.0000
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Total 483 435.250000 17206.4500 1000.0000