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
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 1749 5015.500000 186492.9000 37.1833
Subtotal (Total Children Is Unduplicated) 1749 5015.500000 186492.9000 37.1833
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 35.000000 2712.8300 77.5094
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 15 29.000000 1737.6800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 271 516.000000 41785.6800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 688.3300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 88.500000 7247.7100 81.8950
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 65.500000 5304.1900 80.9800
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 224 424.500000 25436.0400 59.9200
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 60 100.500000 8138.4900 80.9800
Subtotal (Total Children Is Unduplicated) 319 1279.000000 93908.5100 73.4234
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Total 6294.500000 280401.4100 44.5471
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Number of Children (Unduplicated) With at Least One Service 1759
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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 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
303 149.750000 5570.7000 0.0000
Other 484 378.500000 14080.2000 0.0000
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Total 6491 6294.500000 280401.4100 0.0000