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
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 38 15.000000 558.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 141.750000 5273.1000 37.2000
Subtotal (Total Children Is Unduplicated) 59 156.750000 5831.1000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 404.9000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
Subtotal (Total Children Is Unduplicated) 4 12.000000 929.6400 77.4700
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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 174.750000 7240.7400 41.4348
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Number of Children (Unduplicated) With at Least One Service 61
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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
230 162.250000 6343.8200 0.0000
Other 4 6.500000 416.9200 0.0000
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Total 237 174.750000 7240.7400 480.0000