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
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 188 98.500000 3720.0000 37.7665
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 238 642.250000 23891.7000 37.2000
Subtotal (Total Children Is Unduplicated) 347 741.750000 27611.7000 37.2251
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 1 3.000000 242.9400 80.9800
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 27 30.000000 1500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 27 30.000000 1500.0000 50.0000
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Total 774.750000 29354.6400 37.8892
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Number of Children (Unduplicated) With at Least One Service 363
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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 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
1317 770.500000 29196.5400 0.0000
Other 11 4.250000 158.1000 0.0000
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Total 1328 774.750000 29354.6400 0.0000