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
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 944 6517.500000 242460.3000 37.2014
Subtotal (Total Children Is Unduplicated) 944 6517.500000 242460.3000 37.2014
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.000000 317.9400 79.4850
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 6.500000 508.4300 78.2200
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.500000 436.4200 79.3491
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 3.500000 283.4300 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.000000 299.6000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 6.500000 376.2200 57.8800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 69.000000 5231.8100 75.8233
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 45 75.000000 5720.6800 76.2757
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 67.500000 5131.9200 76.0284
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 38 65.000000 4943.7700 76.0580
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 32.500000 2476.3700 76.1960
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 48.000000 3656.8100 76.1835
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 65.000000 3653.9100 56.2140
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 53 93.000000 5210.1200 56.0228
Subtotal (Total Children Is Unduplicated) 171 550.500000 38596.8900 70.1124
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 2 23.000000 1870.3600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 14.000000 1138.4800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 3 40.000000 3252.8000 81.3200
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Total 7108.000000 284309.9900 39.9986
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Number of Children (Unduplicated) With at Least One Service 945
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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
10215 7108.000000 284309.9900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10215 7108.000000 284309.9900 0.0000