CMS/EIP Fiscal Report Center: 10
Services beginning 04/01/2025 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 272 1202.250000 44733.0000 37.2077
Subtotal (Total Children Is Unduplicated) 272 1202.250000 44733.0000 37.2077
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 22.500000 1822.0500 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 1.500000 121.4700 80.9800
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 12 20.500000 1228.3600 59.9200
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 138 229.500000 18584.9100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 21.500000 1741.0700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 93.000000 7531.1400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.500000 526.3700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 81.000000 6559.3800 80.9800
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 146 247.500000 14830.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 389.4800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 43 59.500000 4939.7800 83.0215
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.500000 202.4500 80.9800
Subtotal (Total Children Is Unduplicated) 227 804.000000 59448.4200 73.9408
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Total 2006.250000 104181.4200 51.9284
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Number of Children (Unduplicated) With at Least One Service 274
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Center 10
Flag Claims Units Chgs Paid
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R 45 45.000000 1674.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 812 1016.750000 53174.6000 0.0000
P 0 0.000000 0.0000 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
746 943.750000 49304.9200 0.0000
Other 2 0.750000 27.9000 0.0000
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Total 1605 2006.250000 104181.4200 0.0000