CMS/EIP Fiscal Report Center: 55
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 367 315.750000 11745.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 54 61.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 225 720.250000 26767.1500 37.1637
Subtotal (Total Children Is Unduplicated) 423 1097.250000 38513.0500 35.0996
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1133.7200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 299.6000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
Subtotal (Total Children Is Unduplicated) 13 25.000000 1877.0800 75.0832
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.500000 75.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 27.000000 1458.0000 54.0000
Subtotal (Total Children Is Unduplicated) 12 43.500000 2158.0000 49.6092
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Total 1165.750000 42548.1300 36.4985
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Number of Children (Unduplicated) With at Least One Service 426
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Center 55
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
1644 1165.750000 42548.1300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1644 1165.750000 42548.1300 0.0000