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
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1159 908.750000 33786.9000 37.1795
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 69.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2345 10394.75000 386628.9000 37.1946
Subtotal (Total Children Is Unduplicated) 2480 11372.50000 420415.8000 36.9678
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 10 19.000000 1120.8000 58.9895
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 2.000000 115.4200 57.7100
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 9 14.500000 1174.2100 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 244 461.500000 27091.7400 58.7037
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 26.500000 1567.9900 59.1694
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 62.000000 5020.7600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
SCREEN-T1023-SCREENING 22 25.000000 1333.5800 53.3432
Subtotal (Total Children Is Unduplicated) 320 618.500000 38066.3600 61.5463
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 5 28.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 5.750000 310.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 3.750000 202.5000 54.0000
Subtotal (Total Children Is Unduplicated) 13 37.500000 513.0000 13.6800
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Total 12028.500000 458995.1600 38.1590
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Number of Children (Unduplicated) With at Least One Service 2483
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 1.000000 37.2000 37.2000
H 0 0.000000 0.0000 0.0000
T 1428 969.250000 36240.6000 36240.6000
17226 11058.250000 422717.3600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18656 12028.500000 458995.1600 36277.8000