CMS/EIP Fiscal Report Center: 06
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 51 24.750000 911.4000 36.8242
TCM-T1017TL-TARGETED CASE MANAGEMENT 107 376.500000 14005.8000 37.2000
Subtotal (Total Children Is Unduplicated) 108 401.250000 14917.2000 37.1768
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 283.4300 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 364.4100 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.000000 299.6000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 25.000000 2024.5000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 30 38.500000 3117.7300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 25.500000 2064.9900 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 11.000000 890.7800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 11.000000 890.7800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 9.000000 728.8200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 24.500000 1468.0400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 29.500000 1767.6400 59.9200
Subtotal (Total Children Is Unduplicated) 87 194.000000 14467.5800 74.5752
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EI Services,Class #03
INTR-T1013-INTERPRETER 7 14.000000 1100.0000 78.5714
Subtotal (Total Children Is Unduplicated) 7 14.000000 1100.0000 78.5714
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Total 609.250000 30484.7800 50.0366
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Number of Children (Unduplicated) With at Least One Service 111
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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 4 8.000000 680.0000 680.0000
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
702 601.250000 29804.7800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 706 609.250000 30484.7800 680.0000