CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2024 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
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.000000 577.1000 57.7100
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 26.500000 2056.2700 77.5951
Subtotal (Total Children Is Unduplicated) 20 47.500000 3419.8900 71.9977
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EI Services,Class #03
INTR-T1013-INTERPRETER 5 15.000000 750.0000 50.0000
TRAV-TRAVS-Travel by mile 27 2057.000000 915.3000 0.4450
Subtotal (Total Children Is Unduplicated) 29 2072.000000 1665.3000 0.8037
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Total 2119.500000 5085.1900 2.3992
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Number of Children (Unduplicated) With at Least One Service 37
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Center 02
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 81 2119.500000 5085.1900 4752.4800
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 81 2119.500000 5085.1900 4752.4800