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
Payclass Filters:GR
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 1033 1209.250000 44984.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 505 2643.750000 98347.5000 37.2000
Subtotal (Total Children Is Unduplicated) 1180 3853.000000 143331.6000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 43 33.500000 1675.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 20.500000 1573.3800 76.7502
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 3.500000 268.4800 76.7086
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 13.000000 772.3300 59.4100
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 23.500000 1366.1300 58.1332
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 6.500000 487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 20.000000 1508.9700 75.4485
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 15 21.000000 1580.9800 75.2848
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.500000 256.3800 56.9733
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 33 50.500000 2816.0100 55.7626
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.500000 187.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 30.000000 2255.9800 75.1993
Subtotal (Total Children Is Unduplicated) 114 234.500000 15170.1100 64.6913
-----------------------------------------------------------------------------------------------------------------------
Total 4087.500000 158501.7100 38.7772
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1191
-----------------------------------------------------------------------------------------------------------------------
Center 04
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 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
3494 4087.500000 158501.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3494 4087.500000 158501.7100 0.0000