CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
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 498 1330.000000 49476.0000 37.2000
Subtotal (Total Children Is Unduplicated) 498 1330.000000 49476.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 5 9.000000 621.7100 69.0789
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 27.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 16.000000 864.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 15.000000 1219.8000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 325.2800 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 16 37.000000 2517.4000 68.0378
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Total 1376.000000 52615.1100 38.2377
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Number of Children (Unduplicated) With at Least One Service 499
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Center 05
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 2226 1182.000000 43970.4000 32375.6600
P 36 38.000000 2656.1100 2656.1100
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
60 32.000000 1375.8000 483.0000
Other 172 124.000000 4612.8000 0.0000
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Total 2494 1376.000000 52615.1100 35514.7700