CMS/EIP Fiscal Report Center: 06
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 38 15.000000 558.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 78 234.750000 8732.7000 37.2000
Subtotal (Total Children Is Unduplicated) 81 249.750000 9290.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.500000 202.4500 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 202.4500 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 29.500000 2388.9100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 31.000000 2510.3800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 28.000000 2267.4400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 25 31.500000 2550.8700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 9.500000 769.3100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 12.000000 971.7600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 23.000000 1378.1600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 30.500000 1827.5600 59.9200
Subtotal (Total Children Is Unduplicated) 85 200.000000 15069.2900 75.3465
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 6.000000 480.0000 80.0000
Subtotal (Total Children Is Unduplicated) 3 6.000000 480.0000 80.0000
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Total 455.750000 24839.9900 54.5035
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Number of Children (Unduplicated) With at Least One Service 86
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Center 06
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 480.0000 480.0000
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
508 443.250000 23943.0700 0.0000
Other 4 6.500000 416.9200 0.0000
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Total 515 455.750000 24839.9900 480.0000