CMS/EIP Fiscal Report Center: 10
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 2957 8295.000000 308499.6000 37.1910
Subtotal (Total Children Is Unduplicated) 2957 8295.000000 308499.6000 37.1910
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 33 66.000000 5223.2100 79.1395
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 9.500000 728.8200 76.7179
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 10.000000 809.8000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 21 42.000000 2516.6400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 432 865.000000 70007.2100 80.9332
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.000000 1376.6600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 85 161.000000 13118.7600 81.4830
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 68 131.000000 10567.8900 80.6709
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 363 717.500000 43022.5600 59.9618
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 97 179.000000 14495.4200 80.9800
Subtotal (Total Children Is Unduplicated) 523 2209.500000 162724.5300 73.6477
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Total 10504.500000 471224.1300 44.8593
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Number of Children (Unduplicated) With at Least One Service 2967
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Center 10
Flag Claims Units Chgs Paid
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R 266 270.750000 10193.5400 0.0000
U 0 0.000000 0.0000 0.0000
B 5438 5495.500000 250556.9700 0.0000
P 0 0.000000 0.0000 0.0000
D 1 0.750000 27.9000 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
4696 4358.000000 196328.3200 0.0000
Other 485 379.500000 14117.4000 0.0000
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Total 10886 10504.500000 471224.1300 0.0000