CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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 2104 2888.250000 107442.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2850 19571.25000 728050.5000 37.2000
Subtotal (Total Children Is Unduplicated) 2887 22459.50000 835493.4000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 49 39.500000 1975.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 22.000000 1760.6300 80.0286
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 60 76.500000 6066.4000 79.2993
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.500000 520.3900 80.0600
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 22 26.500000 2110.0900 79.6260
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 17 22.000000 1300.5600 59.1164
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 55 89.500000 5281.0700 59.0064
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.000000 971.7600 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 14 17.000000 1376.6600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 172.000000 13626.5700 79.2242
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 570 748.500000 59447.4300 79.4221
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 61 65.000000 5191.9400 79.8760
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 308 387.500000 30711.3600 79.2551
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 225.000000 13294.1500 59.0851
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 796 1344.000000 78927.7700 58.7260
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 150 243.000000 19328.3100 79.5404
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 515 840.500000 66582.0200 79.2172
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 304.0000 304.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 219 219.000000 27362.8000 124.9443
Subtotal (Total Children Is Unduplicated) 1279 4557.000000 336138.9100 73.7632
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 66.0000 33.0000
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Total 27018.500000 1171698.3100 43.3665
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Number of Children (Unduplicated) With at Least One Service 3012
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Center 04
Flag Claims Units Chgs Paid
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R 132 225.000000 8370.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3275 5218.500000 222602.7200 0.0000
P 5024 8722.250000 357097.4800 365960.3000
D 152 238.500000 10504.9400 0.0000
S 5 11.750000 437.1000 0.0000
H 1 1.000000 54.0000 0.0000
T 2 4.000000 148.8000 0.0000
10569 12589.500000 572185.6700 0.0000
Other 6 8.000000 297.6000 0.0000
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Total 19166 27018.500000 1171698.3100 365960.3000