CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2025 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 727 403.250000 15112.5000 37.4768
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1810 5964.000000 221935.2000 37.2125
Subtotal (Total Children Is Unduplicated) 1816 6368.750000 237047.7000 37.2204
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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 2 3.000000 242.9400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 2.500000 202.4500 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 149.8000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 88 102.500000 8300.4500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 83 110.500000 8948.2900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 77 91.000000 7369.1800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 70 101.000000 8178.9800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 47.500000 3806.0600 80.1276
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 51.500000 4170.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 96.000000 5752.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 110 153.500000 9197.7200 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 314 769.500000 56912.6500 73.9606
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 7.000000 350.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 290 304.500000 15225.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 28.250000 2297.2900 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 0.500000 40.6600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 18.000000 1463.7600 81.3200
Subtotal (Total Children Is Unduplicated) 303 359.250000 19401.7100 54.0062
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Total 7497.500000 313362.0600 41.7955
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Number of Children (Unduplicated) With at Least One Service 1816
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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
11069 7436.750000 310882.8300 0.0000
Other 114 60.750000 2479.2300 0.0000
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Total 11183 7497.500000 313362.0600 0.0000