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
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 810 3793.500000 141127.5000 37.2025
Subtotal (Total Children Is Unduplicated) 810 3793.500000 141127.5000 37.2025
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 36 67.500000 5397.3800 79.9612
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.000000 566.8600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 32 59.000000 3504.3400 59.3956
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 5.000000 404.9000 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 569 1006.500000 79996.6700 79.4800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 38 67.500000 5322.6300 78.8538
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 165 269.000000 21448.7400 79.7351
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 22.000000 1730.7300 78.6695
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 185 319.000000 25209.0800 79.0253
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 404.9000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 493 873.500000 51481.0800 58.9366
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 24.000000 1404.9300 58.5388
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 136 217.000000 17590.2300 81.0610
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 7.000000 539.9500 77.1357
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 6.000000 348.6600 58.1100
Subtotal (Total Children Is Unduplicated) 775 2966.000000 216218.9900 72.8992
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 65.000000 3418.0000 52.5846
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 89.000000 1068.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 17.500000 1343.5400 76.7737
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 17.000000 1295.8600 76.2271
Subtotal (Total Children Is Unduplicated) 3 190.500000 7155.4000 37.5612
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Total 6950.000000 364501.8900 52.4463
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Number of Children (Unduplicated) With at Least One Service 824
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Center 10
Flag Claims Units Chgs Paid
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R 202 212.500000 7905.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2622 3204.750000 170357.4500 0.0000
P 144 142.250000 4692.8300 2317.2300
D 1 0.500000 18.6000 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
2679 3389.250000 181500.1100 0.0000
Other 2 0.750000 27.9000 0.0000
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Total 5650 6950.000000 364501.8900 2317.2300