CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 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 2 0.500000 18.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 32.000000 1190.4000 37.2000
Subtotal (Total Children Is Unduplicated) 8 32.500000 1209.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 39.3700 26.2467
Subtotal (Total Children Is Unduplicated) 2 3.500000 180.2700 51.5057
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EI Services,Class #03
INTR-T1013-INTERPRETER 4 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 11.000000 132.0000 12.0000
Subtotal (Total Children Is Unduplicated) 6 18.000000 482.0000 26.7778
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Total 54.000000 1871.2700 34.6531
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Number of Children (Unduplicated) With at Least One Service 13
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Center 01
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 15 17.250000 454.4200 454.4200
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 2 3.250000 126.8700 126.8700
50 33.500000 1289.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 67 54.000000 1871.2700 581.2900