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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 622 2491.500000 92618.7000 37.1739
Subtotal (Total Children Is Unduplicated) 622 2491.500000 92618.7000 37.1739
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 25.000000 2012.5400 80.5016
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 3 6.000000 359.5200 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 93 186.000000 14942.6800 80.3370
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 22.000000 1781.5600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 66.000000 3937.0400 59.6521
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
Subtotal (Total Children Is Unduplicated) 122 321.000000 24118.4200 75.1353
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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 3125.250000 135729.2600 43.4299
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Number of Children (Unduplicated) With at Least One Service 627
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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 1431 1441.750000 66343.2600 0.0000
P 1793 1683.500000 69386.0000 68950.7400
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 3224 3125.250000 135729.2600 68950.7400