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
Payclass Filters:MED
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 154 479.750000 17846.7000 37.2000
Subtotal (Total Children Is Unduplicated) 154 479.750000 17846.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 83 140.000000 10575.0000 75.5357
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 39.500000 2962.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 50.000000 3712.5000 74.2500
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 98.500000 5439.0000 55.2183
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 30.500000 2336.9600 76.6216
Subtotal (Total Children Is Unduplicated) 110 385.500000 26914.4600 69.8170
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 22.000000 1100.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 10.250000 751.6300 73.3298
Subtotal (Total Children Is Unduplicated) 1 32.250000 1851.6300 57.4149
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Total 897.500000 46612.7900 51.9363
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Number of Children (Unduplicated) With at Least One Service 158
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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 11 17.000000 1128.7500 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
47 35.750000 1981.8300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 785 897.500000 46612.7900 0.0000