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
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 38 55.500000 2064.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 92 289.500000 10750.8000 37.1358
Subtotal (Total Children Is Unduplicated) 105 345.000000 12815.4000 37.1461
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.500000 509.3200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1517.9400 75.8970
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 33.000000 2564.7000 77.7182
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 58.500000 3366.0900 57.5400
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 59 127.500000 8565.4000 67.1796
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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 4 6.750000 542.5000 80.3704
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 17.000000 204.0000 12.0000
TRAV-TRAVS-Travel by mile 2 220.000000 97.8700 0.4449
Subtotal (Total Children Is Unduplicated) 8 246.250000 899.3700 3.6523
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Total 718.750000 22280.1700 30.9985
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Number of Children (Unduplicated) With at Least One Service 120
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Center 03
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 64 279.750000 4903.9600 4903.9600
D 0 0.000000 0.0000 0.0000
S 4 19.000000 37.5600 37.5600
H 0 0.000000 0.0000 0.0000
T 94 110.000000 4421.4000 4421.4000
266 310.000000 12917.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 428 718.750000 22280.1700 9362.9200