CMS/EIP Fiscal Report Center: 09
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 1079 1932.000000 71964.6000 37.2488
TCM-T1017TL-TARGETED CASE MANAGEMENT 1349 3950.500000 146958.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1524 5882.500000 218923.2000 37.2160
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 166 280.000000 14000.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.000000 485.8800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 269.6400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 569.2400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 86.000000 6964.2800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 59.000000 4777.8200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 27.500000 2226.9500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 23 42.500000 3441.6500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 890.7800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 12 22.500000 1822.0500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 75 139.000000 8371.0000 60.2230
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 130 249.000000 14920.0800 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 255.6500 63.9125
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 483 953.500000 59956.2800 62.8802
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 23.250000 1162.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 7 9.500000 475.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 5.500000 137.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 6 6.000000 300.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 60 148.750000 161.9600 1.0888
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 33 158.000000 8532.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 12.000000 648.0000 54.0000
INTR-T1013-INTERPRETER 85 406.000000 20300.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 25.000000 2033.0000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 3 4.000000 325.2800 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 4 15.000000 1219.8000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 85.000000 6912.2000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 325.2800 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 16.000000 1301.1200 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 569.2400 81.3200
Subtotal (Total Children Is Unduplicated) 169 932.000000 44752.8800 48.0181
-----------------------------------------------------------------------------------------------------------------------
Total 7768.000000 323632.3600 41.6623
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1686
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2315 2392.500000 93605.5200 93605.5200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1640 1893.750000 86415.1200 85987.3200
T 1474 1601.500000 65010.0300 65010.0300
1716 1878.250000 78481.8500 0.0000
Other 1 2.000000 119.8400 0.0000
---------------------------------------------------------
Total 7146 7768.000000 323632.3600 244602.8700