CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 18 8.000000 297.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 246 960.500000 35730.6000 37.2000
Subtotal (Total Children Is Unduplicated) 253 968.500000 36028.2000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 161.9600 107.9733
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 389.4800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 242.9400 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 12.000000 971.7600 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 7 9.500000 769.3100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 20.500000 1660.0900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 7.000000 566.8600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 76 111.500000 6681.0800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 29.500000 1767.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 91.000000 7369.1800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 39.000000 3076.1200 78.8749
Subtotal (Total Children Is Unduplicated) 160 353.000000 25376.0200 71.8867
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 324.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 4.000000 60.0000 15.0000
INTR-T1013-INTERPRETER 22 37.250000 1862.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 17.000000 204.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 17 349.000000 159.0800 0.4558
Subtotal (Total Children Is Unduplicated) 41 418.250000 3016.1800 7.2114
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Total 1739.750000 64420.4000 37.0285
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Number of Children (Unduplicated) With at Least One Service 256
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Center 01
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 90 264.000000 5368.8000 5368.8000
D 5 8.000000 510.9500 0.0000
S 233 276.750000 15941.3000 0.0000
H 524 484.250000 20931.0500 15186.9000
T 55 249.250000 4037.1700 4037.1700
537 449.750000 17342.8300 0.0000
Other 15 7.750000 288.3000 0.0000
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Total 1459 1739.750000 64420.4000 24592.8700