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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 6.750000 251.1000 37.2000
Subtotal (Total Children Is Unduplicated) 4 6.750000 251.1000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
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 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 149.8000 59.9200
Subtotal (Total Children Is Unduplicated) 5 12.000000 867.0700 72.2558
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 6.250000 508.2500 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 0.500000 40.6600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 9.000000 731.8800 81.3200
Subtotal (Total Children Is Unduplicated) 3 15.750000 1280.7900 81.3200
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Total 34.500000 2398.9600 69.5351
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Number of Children (Unduplicated) With at Least One Service 11
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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
41 34.500000 2398.9600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 41 34.500000 2398.9600 0.0000