CMS/EIP Fiscal Report Center: 55
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 938 769.250000 28608.5500 37.1902
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 64 56.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1206 5310.500000 197569.2000 37.2035
Subtotal (Total Children Is Unduplicated) 1238 6135.750000 226177.7500 36.8623
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 60.000000 4500.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 119 238.000000 17850.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 26 52.000000 3911.9600 75.2300
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 84.000000 4662.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1238.6800 56.3036
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 187 483.000000 33891.0500 70.1678
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 20.000000 1000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 24.000000 1200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 60 495.500000 24779.0000 50.0081
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 77.000000 5540.9200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 11 66.000000 4749.3600 71.9600
Subtotal (Total Children Is Unduplicated) 91 696.500000 37741.2400 54.1870
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Total 7315.250000 297810.0400 40.7108
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Number of Children (Unduplicated) With at Least One Service 1245
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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 421 414.500000 19604.6000 46.5000
P 3031 2862.000000 118032.6400 118005.2000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 26 50.000000 3735.3300 0.0000
T 0 0.000000 0.0000 0.0000
5360 3988.750000 156437.4700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8838 7315.250000 297810.0400 118051.7000