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
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 9 5.500000 204.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 84 289.000000 10750.8000 37.2000
Subtotal (Total Children Is Unduplicated) 89 294.500000 10955.4000 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 119.8600 59.9300
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.500000 269.6400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 8 15.000000 1035.7100 69.0473
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EI Services,Class #03
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) 32 354.750000 1756.8200 4.9523
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Total 664.250000 13747.9300 20.6969
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Number of Children (Unduplicated) With at Least One Service 110
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Center 01
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 37 234.500000 2165.4300 2165.4300
D 5 100.000000 74.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 33.750000 463.1800 463.1800
362 296.000000 11045.2800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 412 664.250000 13747.9300 2628.6100