CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 262 177.750000 6612.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 54.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 721 1481.500000 55065.3000 37.1686
Subtotal (Total Children Is Unduplicated) 847 1713.250000 61677.6000 36.0004
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 179.7600 59.9200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 86.000000 5153.1200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 299.6000 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
Subtotal (Total Children Is Unduplicated) 46 97.500000 5915.9100 60.6760
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 1.750000 94.5000 54.0000
Subtotal (Total Children Is Unduplicated) 2 1.750000 94.5000 54.0000
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Total 1812.500000 67688.0100 37.3451
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Number of Children (Unduplicated) With at Least One Service 861
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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 0 0.000000 0.0000 0.0000
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
2854 1812.500000 67688.0100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2854 1812.500000 67688.0100 0.0000