CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1133.7200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 40.500000 2426.7600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 37.000000 2996.2600 80.9800
Subtotal (Total Children Is Unduplicated) 34 101.500000 7366.5400 72.5767
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 4 4.000000 60.0000 15.0000
INTR-T1013-INTERPRETER 1 4.000000 200.0000 50.0000
TRAV-TRAVS-Travel by mile 38 1794.000000 798.2800 0.4450
Subtotal (Total Children Is Unduplicated) 41 1802.000000 1058.2800 0.5873
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Total 1903.500000 8424.8200 4.4260
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Number of Children (Unduplicated) With at Least One Service 60
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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 52 1057.500000 3916.8900 3916.8800
59 846.000000 4507.9300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 111 1903.500000 8424.8200 3916.8800