CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 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 654 2309.750000 85922.7000 37.2000
Subtotal (Total Children Is Unduplicated) 654 2309.750000 85922.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 33 41.500000 3360.6700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 19.000000 1538.6200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 149.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 60 73.500000 4404.1200 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 17.500000 1417.1500 80.9800
Subtotal (Total Children Is Unduplicated) 64 157.000000 11092.2400 70.6512
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 216.0000 54.0000
Subtotal (Total Children Is Unduplicated) 1 4.000000 216.0000 54.0000
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Total 2470.750000 97230.9400 39.3528
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Number of Children (Unduplicated) With at Least One Service 664
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Center 04
Flag Claims Units Chgs Paid
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R 69 94.250000 3506.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 1202 1929.750000 76993.1000 0.0000
P 242 446.750000 16731.7400 16737.8000
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 1513 2470.750000 97230.9400 16737.8000