CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 647 306.250000 11392.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1698 5610.750000 208747.8000 37.2050
Subtotal (Total Children Is Unduplicated) 1708 5919.000000 220140.3000 37.1921
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 2.500000 202.4500 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.500000 269.6400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 6.500000 389.4800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 90 108.000000 8724.7800 80.7850
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 87 104.500000 8462.4100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 75 89.500000 7247.7100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 78 103.000000 8340.9400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 39 48.000000 3887.0400 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 35 45.000000 3612.5100 80.2780
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 107 134.500000 8092.4600 60.1670
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 93 123.000000 7370.1600 59.9200
Subtotal (Total Children Is Unduplicated) 315 780.500000 57530.8500 73.7103
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 16.750000 837.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 257 214.000000 10700.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 22.500000 1829.7000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 19.000000 1545.0800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 4.250000 345.6100 81.3200
Subtotal (Total Children Is Unduplicated) 278 278.500000 15364.2100 55.1677
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Total 6978.000000 293035.3600 41.9942
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Number of Children (Unduplicated) With at Least One Service 1708
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Center 06
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 0 0.000000 0.0000 0.0000
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
10218 6928.500000 290576.0600 0.0000
Other 76 49.500000 2459.3000 0.0000
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Total 10294 6978.000000 293035.3600 0.0000