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:TPIN
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 1 0.250000 9.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 10 68.000000 2529.6000 37.2000
Subtotal (Total Children Is Unduplicated) 10 68.250000 2538.9000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.000000 233.9700 77.9900
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 230.9800 76.9933
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 230.9800 76.9933
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.500000 200.8800 57.3943
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 25.500000 1936.4200 75.9380
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 44.000000 3326.9100 75.6116
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 32.000000 2423.9200 75.7475
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 44.000000 3326.9100 75.6116
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 22.500000 1688.1500 75.0289
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.000000 1678.2600 55.9420
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 28 51.500000 2932.6100 56.9439
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 85 281.500000 19587.7200 69.5834
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EI Services,Class #03
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 40.750000 3262.3100 80.0567
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.500000 121.9800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 55.000000 4332.2000 78.7673
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 16.000000 1235.6000 77.2250
Subtotal (Total Children Is Unduplicated) 8 115.250000 9049.0500 78.5167
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Total 465.000000 31175.6700 67.0445
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Number of Children (Unduplicated) With at Least One Service 97
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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
397 465.000000 31175.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 397 465.000000 31175.6700 0.0000