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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
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 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 10 20.000000 1619.6000 80.9800
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 35.000000 2846.2000 81.3200
Subtotal (Total Children Is Unduplicated) 6 35.000000 2846.2000 81.3200
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Total 55.000000 4465.8000 81.1964
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Number of Children (Unduplicated) With at Least One Service 16
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 12.000000 971.7600 0.0000
T 0 0.000000 0.0000 0.0000
39 43.000000 3494.0400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 45 55.000000 4465.8000 0.0000