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
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 3.000000 111.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1 3.000000 111.6000 37.2000
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Screening, Eval, and Assessment,Class #02
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 50.0000 50.0000
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.250000 0.0000 0.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 3 2.250000 81.3200 36.1422
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Total 6.250000 242.9200 38.8672
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Number of Children (Unduplicated) With at Least One Service 5
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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 4 3.250000 131.3200 131.3200
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
1 3.000000 111.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5 6.250000 242.9200 131.3200