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
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 905 731.000000 27193.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 105 70.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 708 2361.250000 87838.5000 37.2000
Subtotal (Total Children Is Unduplicated) 1107 3162.250000 115031.7000 36.3765
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 48.000000 3887.0400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 41.000000 2456.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 56 118.000000 8332.3500 70.6131
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EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 24.500000 1225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 25.000000 1250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 167.500000 9045.0000 54.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 569.2400 81.3200
Subtotal (Total Children Is Unduplicated) 51 224.500000 12101.7400 53.9053
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Total 3504.750000 135465.7900 38.6521
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Number of Children (Unduplicated) With at Least One Service 1112
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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 0 0.000000 0.0000 0.0000
P 1 0.250000 9.3000 9.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 119.8400 0.0000
T 0 0.000000 0.0000 0.0000
4771 3502.500000 135336.6500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4773 3504.750000 135465.7900 9.3000