CMS/EIP Fiscal Report Center: 06
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 48 27.250000 1004.4000 36.8587
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 47 196.250000 7319.1000 37.2948
Subtotal (Total Children Is Unduplicated) 67 225.250000 8323.5000 36.9523
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 4 14.000000 981.7500 70.1250
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 6.000000 360.0000 60.0000
Subtotal (Total Children Is Unduplicated) 3 6.000000 360.0000 60.0000
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Total 245.250000 9665.2500 39.4098
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Number of Children (Unduplicated) With at Least One Service 68
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Center 06
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 3 6.000000 360.0000 360.0000
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
273 237.750000 9249.4500 0.0000
Other 4 1.500000 55.8000 0.0000
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Total 280 245.250000 9665.2500 360.0000