CMS/EIP Fiscal Report Center: 55
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 785 7064.250000 262799.4000 37.2013
Subtotal (Total Children Is Unduplicated) 785 7064.250000 262799.4000 37.2013
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 84 166.000000 13095.8400 78.8906
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 17 34.000000 2681.5600 78.8694
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 21 41.000000 2403.6800 58.6263
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 12.000000 719.0400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 128 256.000000 19666.4400 76.8220
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 40.000000 3107.6400 77.6910
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 122.000000 6912.4400 56.6593
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1274.0400 57.9109
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 263 695.000000 49976.9000 71.9092
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 615.500000 32297.0000 52.4728
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 30.000000 2261.7600 75.3920
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 19 241.750000 19041.3500 78.7646
Subtotal (Total Children Is Unduplicated) 53 887.250000 53600.1100 60.4115
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Total 8646.500000 366376.4100 42.3728
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Number of Children (Unduplicated) With at Least One Service 787
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Center 55
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4637 4338.750000 186783.3700 18.6000
P 4555 4307.750000 179593.0400 179138.1200
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9192 8646.500000 366376.4100 179156.7200