CMS/EIP Fiscal Report Center: 09
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 154 330.500000 12294.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 200 607.000000 22580.4000 37.2000
Subtotal (Total Children Is Unduplicated) 202 937.500000 34875.0000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 75.000000 5625.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 35.500000 2662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 53.500000 4012.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 87 153.500000 11398.5000 74.2573
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 31.500000 2362.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 74 129.000000 7237.5000 56.1047
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 95 163.500000 9074.2500 55.5000
Subtotal (Total Children Is Unduplicated) 194 690.500000 45726.0000 66.2216
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 3.000000 0.0000 0.0000
INTR-T1013-INTERPRETER 6 17.750000 887.5000 50.0000
TRAV-TRAVS-Travel by mile 8 416.000000 185.1200 0.4450
Subtotal (Total Children Is Unduplicated) 14 436.750000 1072.6200 2.4559
-----------------------------------------------------------------------------------------------------------------------
Total 2064.750000 81673.6200 39.5562
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 210
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 725 1348.000000 43200.8700 40460.3700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 402 589.250000 29964.0000 22372.3500
T 0 0.000000 0.0000 0.0000
51 97.000000 6576.0000 6576.0000
Other 16 30.500000 1932.7500 0.0000
---------------------------------------------------------
Total 1194 2064.750000 81673.6200 69408.7200