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
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 523 1221.250000 45430.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 370 1333.000000 49587.6000 37.2000
Subtotal (Total Children Is Unduplicated) 657 2554.250000 95018.1000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 117 182.000000 9100.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
Subtotal (Total Children Is Unduplicated) 120 191.000000 9755.1100 51.0739
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.500000 75.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 18 28.500000 1425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 10.000000 250.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 34 70.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 32.000000 1728.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 162.0000 54.0000
INTR-T1013-INTERPRETER 23 100.250000 5012.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 80 250.750000 8996.4600 35.8782
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Total 2996.000000 113769.6700 37.9739
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Number of Children (Unduplicated) With at Least One Service 708
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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 2312 2353.250000 89178.6500 89178.6500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 375 366.250000 13752.9000 13752.9000
250 276.500000 10838.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2937 2996.000000 113769.6700 102931.5500