CMS/EIP Fiscal Report Center: 55
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
CASE-CASE-NON-TCM CASE MANAGEMENT 971 867.250000 33173.1000 38.2509
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 94 101.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1222 5372.500000 204322.7500 38.0312
Subtotal (Total Children Is Unduplicated) 1257 6340.750000 237495.8500 37.4555
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 68.000000 5506.6400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 18.000000 1457.6400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.000000 719.0400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 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 150 299.000000 24213.0200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 50.000000 4049.0000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 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 41 82.000000 4913.4400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2276.9600 59.9200
Subtotal (Total Children Is Unduplicated) 230 579.000000 43981.1400 75.9605
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.500000 75.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 16.000000 800.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 12 10.000000 250.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 18 18.000000 900.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 11 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 297.000000 16038.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 18.000000 972.0000 54.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 73.000000 5936.3600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 16 91.750000 7461.1100 81.3200
Subtotal (Total Children Is Unduplicated) 68 534.250000 32657.4700 61.1277
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Total 7454.000000 314134.4600 42.1431
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Number of Children (Unduplicated) With at Least One Service 1261
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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 3287 3282.250000 143680.1500 0.0000
P 1 0.250000 9.3000 9.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 36 67.000000 5427.3600 0.0000
T 0 0.000000 0.0000 0.0000
5366 4104.500000 165017.6500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8690 7454.000000 314134.4600 9.3000