CMS/EIP Fiscal Report Center: 09
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 152 327.000000 12164.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 325.250000 12099.3000 37.2000
Subtotal (Total Children Is Unduplicated) 156 652.250000 24263.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 274.4600 78.4171
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 230.8400 57.7100
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 461.9600 76.9933
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 311.9600 77.9900
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 271.4700 77.5629
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 7.500000 595.3900 79.3853
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 583.4300 77.7907
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 320.7200 58.3127
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.000000 863.4400 57.5627
Subtotal (Total Children Is Unduplicated) 23 61.000000 4251.1700 69.6913
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 3.000000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 2 31.000000 465.0000 15.0000
INTR-T1013-INTERPRETER 5 23.000000 1150.0000 50.0000
TRAV-TRAVS-Travel by mile 10 916.000000 407.5100 0.4449
Subtotal (Total Children Is Unduplicated) 15 974.000000 2072.5100 2.1278
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Total 1687.250000 30587.3800 18.1285
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Number of Children (Unduplicated) With at Least One Service 160
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Center 09
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 708 1609.250000 30039.3900 30039.3900
D 8 69.000000 88.9200 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 1.000000 37.2000 37.2000
2 2.500000 138.4400 0.0000
Other 3 5.500000 283.4300 0.0000
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Total 723 1687.250000 30587.3800 30076.5900