CMS/EIP Fiscal Report Center: 57
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 47 41.250000 1534.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 57 340.000000 12648.0000 37.2000
Subtotal (Total Children Is Unduplicated) 80 381.250000 14182.5000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 526.3700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 12.000000 971.7600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 7.500000 607.3500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 27.000000 1617.8400 59.9200
Subtotal (Total Children Is Unduplicated) 17 53.000000 3723.3200 70.2513
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 324.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 6.000000 90.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
Subtotal (Total Children Is Unduplicated) 1 15.000000 526.0000 35.0667
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Total 449.250000 18431.8200 41.0280
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Number of Children (Unduplicated) With at Least One Service 81
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Center 57
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 0 0.000000 0.0000 0.0000
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 7 7.000000 257.0000 257.0000
299 442.250000 18174.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 306 449.250000 18431.8200 257.0000