CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 76 273.250000 10164.9000 37.2000
Subtotal (Total Children Is Unduplicated) 76 273.250000 10164.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 473.9200 78.9867
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 271.4700 77.5629
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 290.7600 58.1520
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 680.2400 59.1513
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 23.000000 1739.9500 75.6500
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 19.000000 1490.7800 78.4621
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 29.500000 2324.7500 78.8051
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 16.500000 1255.4400 76.0873
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 424.4600 77.1745
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 44.500000 2480.8000 55.7483
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 30 53.000000 3096.3300 58.4213
Subtotal (Total Children Is Unduplicated) 68 242.000000 16433.8000 67.9083
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 47.000000 2466.0000 52.4681
Subtotal (Total Children Is Unduplicated) 2 47.000000 2466.0000 52.4681
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Total 562.250000 29064.7000 51.6936
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Number of Children (Unduplicated) With at Least One Service 79
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Center 09
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 279 407.250000 18816.7500 18816.7500
T 0 0.000000 0.0000 0.0000
89 126.500000 8182.6000 6702.3100
Other 16 28.500000 2065.3500 0.0000
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Total 384 562.250000 29064.7000 25519.0600