CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 262 867.500000 32271.0000 37.2000
Subtotal (Total Children Is Unduplicated) 262 867.500000 32271.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 239.500000 18097.3000 75.5628
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 24.000000 1800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 57.000000 4286.9600 75.2098
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 86.500000 6467.9400 74.7739
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 104 175.500000 9803.3600 55.8596
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 53.000000 4045.3900 76.3281
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 190 674.500000 47143.2000 69.8936
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 22.000000 1100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 39.000000 468.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 8.500000 611.6600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 10.750000 787.6100 73.2660
Subtotal (Total Children Is Unduplicated) 1 80.250000 2967.2700 36.9753
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Total 1622.250000 82381.4700 50.7822
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Number of Children (Unduplicated) With at Least One Service 268
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Center 10
Flag Claims Units Chgs Paid
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R 43 40.750000 1515.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 684 804.000000 41986.3100 0.0000
P 68 65.000000 2244.3900 1115.6400
D 1 0.500000 18.6000 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
583 712.000000 36616.2700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1379 1622.250000 82381.4700 1115.6400