CMS/EIP Fiscal Report Center: 09
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 82 116.000000 4315.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 162 408.000000 15196.2000 37.2456
Subtotal (Total Children Is Unduplicated) 171 524.000000 19511.4000 37.2355
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.500000 688.3300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.000000 599.2000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 48.000000 3887.0400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 50 81.000000 6599.8700 81.4799
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 37.500000 3036.7500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 90 156.000000 12632.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 35.500000 2874.7900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 23.500000 1903.0300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 68 113.000000 6813.0800 60.2927
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 147 246.000000 14914.6400 60.6286
Subtotal (Total Children Is Unduplicated) 223 768.500000 54634.6800 71.0926
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EI Services,Class #03
INTR-T1013-INTERPRETER 12 49.250000 2462.5000 50.0000
TRAV-TRAVS-Travel by mile 3 80.000000 35.6000 0.4450
Subtotal (Total Children Is Unduplicated) 15 129.250000 2498.1000 19.3277
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Total 1421.750000 76644.1800 53.9083
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Number of Children (Unduplicated) With at Least One Service 228
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Center 09
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 177 306.000000 12680.5900 12680.5900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 357 549.500000 31810.4200 15252.4700
T 127 183.250000 9445.6200 9445.6200
128 236.000000 11784.4100 1376.6600
Other 79 147.000000 10923.1400 0.0000
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Total 868 1421.750000 76644.1800 38755.3400