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
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 756 421.500000 15698.4000 37.2441
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 6.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 810 2406.000000 89503.2000 37.2000
Subtotal (Total Children Is Unduplicated) 1213 2834.250000 105201.6000 37.1180
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 0.250000 12.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 9 26.250000 1734.1600 66.0632
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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-97530GT-OT SESSION BY LICENSED OT 1 0.500000 35.9800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 14.250000 1039.4700 72.9453
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 10.750000 818.0300 76.0958
Subtotal (Total Children Is Unduplicated) 34 75.250000 4349.7300 57.8037
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Total 2935.750000 111285.4900 37.9070
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Number of Children (Unduplicated) With at Least One Service 1224
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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
4603 2843.500000 107853.7900 0.0000
Other 187 92.250000 3431.7000 0.0000
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Total 4790 2935.750000 111285.4900 0.0000