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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 2130 3304.250000 124742.6500 37.7522
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 301 318.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2244 21462.50000 802731.2500 37.4016
Subtotal (Total Children Is Unduplicated) 2280 25084.75000 927473.9000 36.9736
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 110 216.000000 17120.9200 79.2635
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 23 46.000000 3641.3600 79.1600
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 28 54.000000 3173.8000 58.7741
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
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 596 1192.000000 94889.6400 79.6054
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 96 196.000000 15537.2000 79.2714
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 6.000000 485.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 181 360.000000 21146.8800 58.7413
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 50 100.000000 5912.4400 59.1244
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 167.6300 55.8767
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 852 2197.000000 163594.4500 74.4627
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 8.500000 425.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 1.500000 75.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 59 74.500000 3725.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 13.000000 325.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 67 84.000000 4200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 19 18.000000 450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 88 1488.750000 78414.5000 52.6714
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 31.000000 1674.0000 54.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 263.000000 20666.4400 78.5796
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 28 313.750000 24896.3900 79.3510
Subtotal (Total Children Is Unduplicated) 152 2299.000000 134973.2900 58.7096
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Total 29580.750000 1226041.6400 41.4473
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Number of Children (Unduplicated) With at Least One Service 2282
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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 8242 8093.750000 354785.9500 46.5000
P 5220 4965.500000 206963.7400 206402.3800
D 1 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 148 268.000000 21308.2200 0.0000
T 0 0.000000 0.0000 0.0000
21438 16252.750000 642955.8300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 35049 29580.750000 1226041.6400 206448.8800