CMS/EIP Fiscal Report Center: 06
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 2132 1577.250000 58803.9000 37.2825
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 11.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3383 23214.50000 863653.8000 37.2032
Subtotal (Total Children Is Unduplicated) 3394 24803.50000 922457.7000 37.1906
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 3 1.750000 87.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 13.000000 1034.8000 79.6000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 10.000000 791.8600 79.1860
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 13.000000 1034.8000 79.6000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 11.500000 919.3100 79.9400
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 6.500000 499.4600 76.8400
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 5.500000 445.3900 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 9.500000 560.4000 58.9895
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 9.500000 555.9800 58.5242
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 343 438.000000 34438.3600 78.6264
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 347 479.000000 37870.1100 79.0608
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 295 390.500000 30684.2300 78.5768
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 297 435.000000 34366.8600 79.0043
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 141 185.000000 14596.9600 78.9025
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 156 230.000000 18089.1500 78.6485
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 335 447.500000 26140.7000 58.4150
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 381 567.500000 33320.4500 58.7144
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 1200 3257.750000 235720.1700 72.3567
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 46.000000 2309.9200 50.2157
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 788 714.000000 35700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 3.000000 75.0000 25.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 74.750000 6027.1900 80.6313
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.500000 121.9800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 1.500000 107.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 90.250000 7079.3900 78.4420
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 34.000000 2643.2000 77.7412
Subtotal (Total Children Is Unduplicated) 841 966.750000 54127.1200 55.9887
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Total 29028.000000 1212304.9900 41.7633
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Number of Children (Unduplicated) With at Least One Service 3394
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Center 06
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 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
41896 28754.000000 1201187.4000 0.0000
Other 518 274.000000 11117.5900 0.0000
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Total 42414 29028.000000 1212304.9900 0.0000