CMS/EIP Fiscal Report Center: 03
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 31 40.250000 1497.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 105 277.750000 10332.3000 37.2000
Subtotal (Total Children Is Unduplicated) 113 318.000000 11829.6000 37.2000
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Screening, Eval, and Assessment,Class #02
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 1 2.000000 119.8400 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 7 13.000000 1005.0400 77.3108
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.500000 1174.2100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 50.500000 3025.9600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 30.000000 2429.4000 80.9800
Subtotal (Total Children Is Unduplicated) 50 114.000000 8078.3700 70.8629
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EI Services,Class #03
INTR-T1013-INTERPRETER 2 2.000000 367.5000 183.7500
Subtotal (Total Children Is Unduplicated) 2 2.000000 367.5000 183.7500
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Total 434.000000 20275.4700 46.7177
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Number of Children (Unduplicated) With at Least One Service 113
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
341 434.000000 20275.4700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 341 434.000000 20275.4700 0.0000