CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1097 4278.250000 159141.6000 37.1978
Subtotal (Total Children Is Unduplicated) 1097 4278.250000 159141.6000 37.1978
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 461.9600 76.9933
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 785.8800 78.5880
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 473.9200 78.9867
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 20.000000 1571.7600 78.5880
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 18.000000 968.7900 53.8217
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 572.6800 57.2680
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 44.000000 3419.6000 77.7182
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 48.000000 3695.6800 76.9933
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 76.000000 5915.2800 77.8326
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2483.7200 77.6163
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 84.000000 6539.2000 77.8476
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 32.000000 2507.6400 78.3638
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 57 114.000000 6583.3600 57.7488
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 54 108.000000 6188.4800 57.3007
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 54.000000 4121.7600 76.3289
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 42.000000 3110.7600 74.0657
SCREEN-T1023-SCREENING 4 4.000000 211.9400 52.9850
Subtotal (Total Children Is Unduplicated) 209 716.000000 50260.2500 70.1959
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Total 4994.250000 209401.8500 41.9286
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Number of Children (Unduplicated) With at Least One Service 1105
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Center 07
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 180 126.000000 4895.8000 0.0000
P 6194 4868.250000 204506.0500 203199.2200
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6374 4994.250000 209401.8500 203199.2200