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
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 17 14.250000 530.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 40 85.500000 3106.2000 36.3298
Subtotal (Total Children Is Unduplicated) 51 99.750000 3636.3000 36.4541
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.000000 647.8400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 931.2700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 43.000000 2576.5600 59.9200
Subtotal (Total Children Is Unduplicated) 29 62.500000 4155.6700 66.4907
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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 192.250000 8234.6500 42.8330
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Number of Children (Unduplicated) With at Least One Service 62
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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
123 155.250000 7309.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 132 192.250000 8234.6500 925.3000