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:MED
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 1062 4116.750000 153133.8000 37.1977
Subtotal (Total Children Is Unduplicated) 1062 4116.750000 153133.8000 37.1977
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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 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 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 16.000000 1259.8000 78.7375
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 821.2000 58.6571
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 452.8400 56.6050
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 21 42.000000 3233.7200 76.9933
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 72.000000 5591.3600 77.6578
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1871.7600 77.9900
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 76.000000 5927.2400 77.9900
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2357.6400 78.5880
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 100.000000 5779.8400 57.7984
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 49 98.000000 5606.9600 57.2139
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3359.8000 76.3591
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2660.7600 73.9100
SCREEN-T1023-SCREENING 3 3.000000 157.9600 52.6533
Subtotal (Total Children Is Unduplicated) 183 631.000000 44396.1600 70.3584
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Total 4747.750000 197529.9600 41.6050
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Number of Children (Unduplicated) With at Least One Service 1070
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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 178 122.000000 4614.0000 0.0000
P 5969 4624.000000 192850.8600 191555.4700
D 1 0.750000 27.9000 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 4 1.000000 37.2000 0.0000
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Total 6152 4747.750000 197529.9600 191555.4700