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
Payclass Filters:GR
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 646 449.500000 16721.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 56.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 892 3524.250000 131055.6000 37.1868
Subtotal (Total Children Is Unduplicated) 1124 4029.750000 147777.0000 36.6715
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 641.4400 58.3127
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 5 7.500000 607.3500 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 64 126.500000 7197.5500 56.8976
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.000000 459.4700 57.4338
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
Subtotal (Total Children Is Unduplicated) 85 163.000000 9588.0700 58.8225
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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 4 4.750000 256.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 3.750000 202.5000 54.0000
Subtotal (Total Children Is Unduplicated) 12 36.500000 459.0000 12.5753
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Total 4229.250000 157824.0700 37.3173
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Number of Children (Unduplicated) With at Least One Service 1130
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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 1365 917.250000 34278.7500 34278.7500
6172 3311.000000 123508.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7539 4229.250000 157824.0700 34315.9500