CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2024 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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 138 166.750000 6203.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 421 1545.000000 57297.3000 37.0856
Subtotal (Total Children Is Unduplicated) 435 1711.750000 63500.4000 37.0968
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 769.3100 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 629.1600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 170.500000 12847.4100 75.3514
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 101 184.000000 14435.7300 78.4551
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 21.500000 1544.0200 71.8149
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 144 261.000000 15482.4600 59.3198
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 30.000000 2429.4000 80.9800
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 261 696.000000 48791.2500 70.1024
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.500000 25.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
INTR-T1013-INTERPRETER 14 22.750000 1995.0000 87.6923
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 17.000000 204.0000 12.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 225.2400 75.0800
TRAV-TRAVS-Travel by mile 2 220.000000 97.8700 0.4449
Subtotal (Total Children Is Unduplicated) 18 265.250000 2577.1100 9.7158
-----------------------------------------------------------------------------------------------------------------------
Total 2673.000000 114868.7600 42.9737
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 439
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 229 573.750000 26786.1200 26786.1200
D 0 0.000000 0.0000 0.0000
S 4 19.000000 37.5600 37.5600
H 4 7.000000 566.8600 566.8600
T 114 127.000000 5053.8000 5053.8000
1604 1946.250000 82424.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1955 2673.000000 114868.7600 32444.3400