CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 756 421.500000 15698.4000 37.2441
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 6.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1768 5725.000000 213007.2000 37.2065
Subtotal (Total Children Is Unduplicated) 1783 6153.250000 228705.6000 37.1683
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 0.250000 12.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 130.000000 9562.5000 73.5577
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 92 164.500000 12337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 77 133.500000 9908.2500 74.2191
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 85 153.000000 11475.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 49.500000 3712.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 78.000000 5820.7500 74.6250
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 121.500000 6660.0000 54.8148
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 105 196.000000 10917.0000 55.6990
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 299 1048.750000 71955.5200 68.6107
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 4.000000 200.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 26 44.000000 2200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.250000 31.2500 25.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.500000 25.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 7.500000 558.4200 74.4560
OCCT-97530GT-OT SESSION BY LICENSED OT 2 1.500000 107.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 32.250000 2362.8300 73.2660
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 20.750000 1565.7100 75.4559
Subtotal (Total Children Is Unduplicated) 37 111.750000 7051.1500 63.0975
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Total 7313.750000 307712.2700 42.0731
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Number of Children (Unduplicated) With at Least One Service 1783
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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
9801 7221.500000 304280.5700 0.0000
Other 187 92.250000 3431.7000 0.0000
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Total 9988 7313.750000 307712.2700 0.0000