CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 173 162.750000 6054.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 371 5955.000000 221526.0000 37.2000
Subtotal (Total Children Is Unduplicated) 372 6117.750000 227580.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 17.000000 1367.6900 80.4524
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.000000 629.9000 78.7375
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 17 27.500000 1627.9100 59.1967
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 122.000000 9622.4200 78.8723
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.000000 1052.7400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 130 193.500000 15343.7200 79.2957
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 11.000000 875.8300 79.6209
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 116 159.500000 12730.9300 79.8177
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 21.000000 1664.7000 79.2714
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 309 480.000000 28222.3600 58.7966
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 41.500000 2449.1100 59.0147
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 20.000000 1556.8100 77.8405
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 362 1119.500000 77589.5100 69.3073
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 250.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 5.000000 75.0000 15.0000
Subtotal (Total Children Is Unduplicated) 1 10.000000 325.0000 32.5000
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Total 7247.250000 305494.8100 42.1532
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Number of Children (Unduplicated) With at Least One Service 374
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Center 57
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 1 1.500000 121.4700 0.0000
S 0 0.000000 0.0000 0.0000
H 1271 2239.750000 110164.5300 110164.5600
T 15 23.500000 1189.1100 1189.1100
1233 4982.500000 194019.7000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2520 7247.250000 305494.8100 111353.6700