CMS/EIP Fiscal Report Center: 52
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 2 1.000000 37.2000 37.2000
Subtotal (Total Children Is Unduplicated) 2 1.000000 37.2000 37.2000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 9.000000 470.0000 52.2222
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 7.000000 84.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 1 0.750000 53.9700 71.9600
TRAV-TRAVS-Travel by mile 1 95.000000 42.2500 0.4447
Subtotal (Total Children Is Unduplicated) 8 114.750000 818.5000 7.1329
-----------------------------------------------------------------------------------------------------------------------
Total 115.750000 855.7000 7.3927
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 10
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
31 115.750000 855.7000 240.7200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 115.750000 855.7000 240.7200