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
Payclass Filters:GR
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 1118 1910.750000 71072.3500 37.1960
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 219 235.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 751 5155.500000 191758.4500 37.1949
Subtotal (Total Children Is Unduplicated) 1177 7301.750000 262830.8000 35.9956
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 37.000000 2936.4600 79.3638
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 311.9600 77.9900
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 14 27.000000 1600.1600 59.2652
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2297.8400 76.5947
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 623.9200 77.9900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1691.5200 56.3840
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 572.6800 57.2680
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 70 155.000000 10614.1300 68.4783
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.500000 325.0000 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 35 40.500000 2025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 39 45.000000 2250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 499.000000 25932.0000 51.9679
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 20.884378 1559.0000 74.6491
Subtotal (Total Children Is Unduplicated) 72 631.384378 32616.0000 51.6579
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Total 8088.134378 306060.9300 37.8407
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Number of Children (Unduplicated) With at Least One Service 1181
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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 1 0.750000 27.9000 27.9000
P 0 0.000000 0.0000 0.0000
D 1 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 119.8400 0.0000
T 0 0.000000 0.0000 0.0000
11311 8084.634378 305885.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11314 8088.134378 306060.9300 27.9000