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
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 125 505.000000 18786.0000 37.2000
Subtotal (Total Children Is Unduplicated) 125 505.000000 18786.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 29.000000 2324.5000 80.1552
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 13 25.000000 1491.3700 59.6548
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 79 135.500000 10410.6700 76.8315
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.500000 964.4100 77.1528
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 40.000000 3092.6900 77.3173
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 424.4600 77.1745
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 46.500000 3488.8700 75.0295
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 95.000000 5413.9400 56.9888
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 284.1300 56.8260
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 21.500000 1669.3100 77.6423
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) 115 428.500000 30457.0000 71.0782
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 58.000000 3044.0000 52.4828
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 15.750000 1198.8900 76.1200
Subtotal (Total Children Is Unduplicated) 1 77.750000 4568.1700 58.7546
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Total 1011.250000 53811.1700 53.2125
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Number of Children (Unduplicated) With at Least One Service 129
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Center 10
Flag Claims Units Chgs Paid
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R 34 35.750000 1329.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 747 883.250000 47172.4300 0.0000
P 2 3.000000 166.5000 0.0000
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
107 89.250000 5142.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 890 1011.250000 53811.1700 0.0000