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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 1935 5122.750000 190261.4000 37.1405
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 126 225.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 835 3146.000000 116929.9000 37.1678
Subtotal (Total Children Is Unduplicated) 2013 8494.500000 307191.3000 36.1636
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 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 3 5.101700 401.1800 78.6365
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
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 6 12.000000 701.3600 58.4467
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 14.000000 830.0400 59.2886
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 11.365500 841.6775 74.0555
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 14.993600 1142.4261 76.1942
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 14.986500 1153.8068 76.9897
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 27.443900 2061.2400 75.1074
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 4.952800 395.3800 79.8296
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 3991.0800 57.0154
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 23 46.000000 2614.8800 56.8452
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.826800 666.9600 75.5608
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.224000 549.1200 76.0133
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 102 260.894800 17206.9204 65.9535
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 99 186.000000 0.0000 0.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 153.2800 76.6400
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 99 191.000000 347.2000 1.8178
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Total 8946.394800 324745.4204 36.2990
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Number of Children (Unduplicated) With at Least One Service 2021
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 215 141.500000 5483.1000 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
16388 8804.894800 319262.3204 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 16603 8946.394800 324745.4204 0.0000