CMS/EIP Fiscal Report Center: 07
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
Payclass Filters:TPIN
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 9 5.750000 213.9000 37.2000
Subtotal (Total Children Is Unduplicated) 9 5.750000 213.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 26.000000 2105.4800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 971.7600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 35.013500 2835.3932 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 20.000000 1619.6000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1619.6000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 809.8000 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.785900 225.6022 80.9800
Subtotal (Total Children Is Unduplicated) 52 137.799400 11158.9954 80.9800
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 1.000000 0.0000 0.0000
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 2 2.000000 81.3200 40.6600
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Total 145.549400 11454.2154 78.6964
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Number of Children (Unduplicated) With at Least One Service 62
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Center 07
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 2 1.799400 145.7154 145.7100
D 4 8.000000 647.8400 0.0000
S 0 0.000000 0.0000 0.0000
H 10 19.000000 1538.9600 0.0000
T 0 0.000000 0.0000 0.0000
64 110.750000 8635.8200 0.0000
Other 3 6.000000 485.8800 0.0000
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Total 83 145.549400 11454.2154 145.7100