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:MED
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 697 6689.000000 248840.1000 37.2014
Subtotal (Total Children Is Unduplicated) 697 6689.000000 248840.1000 37.2014
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 66 130.000000 10276.2400 79.0480
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 14 28.000000 2219.6000 79.2714
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 13 25.000000 1453.8000 58.1520
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 150.000000 11572.9200 77.1528
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 28.000000 2159.8000 77.1357
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 72.000000 4110.9200 57.0961
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 923.3600 57.7100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 186 461.000000 33432.0600 72.5207
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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 8037.250000 335872.2700 41.7895
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Number of Children (Unduplicated) With at Least One Service 697
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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 4548 4171.000000 178612.3100 18.6000
P 4320 3866.250000 157259.9600 156870.5600
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 8868 8037.250000 335872.2700 156889.1600