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
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 102 47.250000 1757.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 249 390.500000 14526.6000 37.2000
Subtotal (Total Children Is Unduplicated) 297 437.750000 16284.3000 37.2000
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Screening, Eval, and Assessment,Class #02
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 2 3.500000 209.7200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 10 15.000000 1113.9900 74.2660
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 54.0000 54.0000
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Total 453.750000 17452.2900 38.4623
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Number of Children (Unduplicated) With at Least One Service 299
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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
971 453.750000 17452.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 971 453.750000 17452.2900 0.0000