CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1981 11000.25000 409053.2000 37.1858
Subtotal (Total Children Is Unduplicated) 1981 11000.25000 409053.2000 37.1858
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 62 119.000000 9374.6200 78.7783
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1109.8000 79.2714
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 14.000000 1109.8000 79.2714
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 51 97.000000 5776.8800 59.5555
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 327 601.000000 46178.3100 76.8358
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 26 51.000000 3908.7200 76.6416
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 112.000000 8707.9700 77.7497
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 7.500000 574.4600 76.5947
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 82 140.000000 10755.7700 76.8269
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 248 449.500000 25621.3000 56.9996
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.000000 958.9700 56.4100
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 115.000000 8858.2200 77.0280
Subtotal (Total Children Is Unduplicated) 447 1747.000000 123702.5000 70.8085
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 428.0000 53.5000
Subtotal (Total Children Is Unduplicated) 3 8.000000 428.0000 53.5000
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Total 12755.250000 533183.7000 41.8011
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Number of Children (Unduplicated) With at Least One Service 1985
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Center 10
Flag Claims Units Chgs Paid
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R 249 219.750000 8307.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 14922 12480.250000 521349.6400 0.0000
P 36 55.250000 3526.3600 428.0000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15207 12755.250000 533183.7000 428.0000