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
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 82 116.000000 4315.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 58 187.500000 6975.0000 37.2000
Subtotal (Total Children Is Unduplicated) 93 303.500000 11290.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 13.500000 1093.2300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 928.7600 59.9200
Subtotal (Total Children Is Unduplicated) 12 41.000000 2951.6300 71.9910
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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 473.750000 16739.9300 35.3349
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Number of Children (Unduplicated) With at Least One Service 106
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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 139 238.000000 7489.8500 7489.8500
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 96 126.750000 5470.4600 5470.4600
52 99.000000 3011.9400 0.0000
Other 5 10.000000 767.6800 0.0000
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Total 292 473.750000 16739.9300 12960.3100