CMS/EIP Fiscal Report Center: 03
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 17 14.250000 530.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 69 156.500000 5747.4000 36.7246
Subtotal (Total Children Is Unduplicated) 77 170.750000 6277.5000 36.7643
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.000000 1214.7000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 23.000000 1862.5400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 46.000000 2756.3200 59.9200
Subtotal (Total Children Is Unduplicated) 35 84.000000 5833.5600 69.4471
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 5.000000 420.0000 84.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
TRAV-TRAVS-Travel by mile 1 24.000000 10.6800 0.4450
Subtotal (Total Children Is Unduplicated) 4 30.000000 442.6800 14.7560
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Total 284.750000 12553.7400 44.0869
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Number of Children (Unduplicated) With at Least One Service 88
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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 3 6.000000 401.6400 401.6400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 31.000000 523.6600 523.6600
T 0 0.000000 0.0000 0.0000
187 247.750000 11628.4400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 196 284.750000 12553.7400 925.3000