CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 12 10.000000 372.0000 37.2000
Subtotal (Total Children Is Unduplicated) 12 10.000000 372.0000 37.2000
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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-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 2.898300 222.7443 76.8534
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.634500 1408.3311 75.5765
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 27.259700 2052.0105 75.2763
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 26.556100 2000.7307 75.3398
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 7.575100 571.2893 75.4167
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.143100 623.5482 76.5738
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 5.745900 441.3830 76.8170
Subtotal (Total Children Is Unduplicated) 52 124.812700 9420.0371 75.4734
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 2.500000 150.0000 60.0000
Subtotal (Total Children Is Unduplicated) 2 2.500000 150.0000 60.0000
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Total 137.312700 9942.0371 72.4044
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Number of Children (Unduplicated) With at Least One Service 65
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Center 07
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 15 12.812700 1020.0371 1019.9800
D 32 64.000000 4800.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
31 34.500000 2172.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 91 137.312700 9942.0371 1019.9800