CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2025 ending 03/31/2025 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 9 5.500000 204.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 184 648.000000 24105.6000 37.2000
Subtotal (Total Children Is Unduplicated) 184 653.500000 24310.2000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 119.8600 59.9300
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.6000 80.9000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 17.500000 988.6800 56.4960
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.500000 1048.6000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 769.3100 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 647.8400 80.9800
Subtotal (Total Children Is Unduplicated) 34 65.500000 4380.5100 66.8780
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 270.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 162.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 2 2.000000 30.0000 15.0000
INTR-T1013-INTERPRETER 20 31.750000 1587.5000 50.0000
TRAV-TRAVS-Travel by mile 13 321.000000 139.3200 0.4340
Subtotal (Total Children Is Unduplicated) 33 362.750000 2188.8200 6.0340
-----------------------------------------------------------------------------------------------------------------------
Total 1081.750000 30879.5300 28.5459
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 188
-----------------------------------------------------------------------------------------------------------------------
Center 01
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 65 277.000000 4889.0600 4889.0600
D 6 102.000000 235.6800 0.0000
S 84 74.250000 2762.1000 0.0000
H 352 282.000000 10702.0900 10612.2100
T 12 40.750000 882.6200 882.6200
362 296.000000 11045.2800 0.0000
Other 11 9.750000 362.7000 0.0000
---------------------------------------------------------
Total 892 1081.750000 30879.5300 16383.8900