CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 681 2713.250000 100867.8000 37.1760
Subtotal (Total Children Is Unduplicated) 681 2713.250000 100867.8000 37.1760
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 35.000000 2810.3800 80.2966
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 838.8800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 125 250.000000 20065.6000 80.2624
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 40.000000 3239.2000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 90.000000 5348.6000 59.4289
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 838.8800 59.9200
Subtotal (Total Children Is Unduplicated) 167 451.000000 33747.2600 74.8276
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 33 235.750000 12730.5000 54.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 406.6000 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 16 72.000000 5855.0400 81.3200
Subtotal (Total Children Is Unduplicated) 50 312.750000 18992.1400 60.7263
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Total 3477.000000 153607.2000 44.1781
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Number of Children (Unduplicated) With at Least One Service 690
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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 1502 1558.750000 72003.7400 0.0000
P 1919 1918.250000 81603.4600 81004.4000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3421 3477.000000 153607.2000 81004.4000