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
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2011 10720.75000 398655.8000 37.1854
Subtotal (Total Children Is Unduplicated) 2011 10720.75000 398655.8000 37.1854
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 90.000000 7050.1200 78.3347
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 5 10.000000 785.8800 78.5880
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 947.8400 78.9867
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 37 70.000000 4165.6700 59.5096
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 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 248 465.500000 35767.6400 76.8370
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 38.500000 2944.3100 76.4756
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 72.000000 5615.2800 77.9900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 93.500000 7266.9000 77.7209
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 192 354.500000 20207.3600 57.0024
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 674.8400 56.2367
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 93.500000 7188.9100 76.8867
Subtotal (Total Children Is Unduplicated) 332 1321.500000 93370.4700 70.6549
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Total 12042.250000 492026.2700 40.8583
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Number of Children (Unduplicated) With at Least One Service 2011
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Center 10
Flag Claims Units Chgs Paid
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R 213 180.000000 6696.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14175 11597.000000 474177.2100 0.0000
P 26 44.250000 2931.8600 0.0000
D 1 0.250000 9.3000 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
374 195.750000 7281.9000 0.0000
Other 33 25.000000 930.0000 0.0000
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Total 14822 12042.250000 492026.2700 0.0000