CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 76 134.500000 5003.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 139 391.000000 14545.2000 37.2000
Subtotal (Total Children Is Unduplicated) 143 525.500000 19548.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 445.3900 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 607.3500 80.9800
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 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 179.7600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.000000 898.8000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 28.500000 2307.9300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 43 70.000000 5668.6000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 32.000000 2591.3600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 61 108.500000 8786.3300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 27.500000 2226.9500 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 19.500000 1579.1100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 82.000000 4955.5600 60.4337
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 109 185.000000 11127.3200 60.1477
Subtotal (Total Children Is Unduplicated) 170 589.000000 41779.3600 70.9327
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 8.000000 432.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 8.000000 120.0000 15.0000
INTR-T1013-INTERPRETER 9 44.750000 2237.5000 50.0000
TRAV-TRAVS-Travel by mile 4 237.000000 105.4600 0.4450
Subtotal (Total Children Is Unduplicated) 14 301.750000 3094.9600 10.2567
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Total 1416.250000 64422.9200 45.4884
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Number of Children (Unduplicated) With at Least One Service 174
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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 323 642.500000 24092.4600 24092.4600
D 8 69.000000 88.9200 0.0000
S 8 15.500000 1213.0700 0.0000
H 260 408.000000 22808.1900 11990.1900
T 45 70.750000 3715.4600 3715.4600
99 154.500000 8485.9100 0.0000
Other 31 56.000000 4018.9100 0.0000
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Total 774 1416.250000 64422.9200 39798.1100