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
Agency Filter:EIP DEI DEIP
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 3172 10247.00000 373508.6000 36.4505
Subtotal (Total Children Is Unduplicated) 3172 10247.00000 373508.6000 36.4505
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 50.000000 4049.0000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 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 25 47.500000 2846.2000 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 434 831.000000 67294.3800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 39.500000 3198.7100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 61 115.000000 9270.5800 80.6137
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 19.000000 1538.6200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 84 161.500000 13037.7800 80.7293
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 391 759.500000 45509.2400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1318.2400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 97 165.500000 13402.1900 80.9800
Subtotal (Total Children Is Unduplicated) 552 2236.000000 163529.9300 73.1350
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Total 12483.000000 537038.5300 43.0216
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Number of Children (Unduplicated) With at Least One Service 3176
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Center 10
Flag Claims Units Chgs Paid
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R 216 200.000000 7467.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 7046 6798.500000 301900.6500 0.0000
P 1 1.500000 55.8000 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
5381 5200.750000 217105.1800 0.0000
Other 370 282.250000 10509.0000 0.0000
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Total 13014 12483.000000 537038.5300 0.0000