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: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 14 10.250000 381.3000 37.2000
Subtotal (Total Children Is Unduplicated) 14 10.250000 381.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 311.9600 77.9900
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 4.898300 384.7043 78.5383
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.634500 820.2911 77.1349
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 27.006400 2055.4182 76.1086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 15.013500 1167.9532 77.7935
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 14.556100 1112.6907 76.4415
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.047200 690.5000 76.3220
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 15.173200 1192.8457 78.6153
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.776000 362.8405 75.9716
Subtotal (Total Children Is Unduplicated) 51 117.105200 9035.0837 77.1536
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 2.500000 150.0000 60.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 287.8400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 6.000000 487.9200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 4 13.500000 1007.0800 74.5985
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Total 140.855200 10423.4637 74.0013
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Number of Children (Unduplicated) With at Least One Service 67
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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 17 19.105200 1529.6037 1278.7400
D 31 58.000000 4423.1200 0.0000
S 0 0.000000 0.0000 0.0000
H 11 19.000000 1479.8400 0.0000
T 0 0.000000 0.0000 0.0000
46 44.750000 2990.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 105 140.855200 10423.4637 1278.7400