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
Payclass Filters:GR
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 43 43.500000 1618.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 45 424.000000 15772.8000 37.2000
Subtotal (Total Children Is Unduplicated) 67 467.500000 17391.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.000000 620.9300 77.6163
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 467.9400 77.9900
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.500000 268.4800 76.7086
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 17.000000 978.8600 57.5800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 13 37.500000 2570.1800 68.5381
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 1 5.000000 75.0000 15.0000
Subtotal (Total Children Is Unduplicated) 1 5.000000 75.0000 15.0000
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Total 510.000000 20036.1800 39.2866
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Number of Children (Unduplicated) With at Least One Service 68
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5 5.000000 75.0000 75.0000
252 505.000000 19961.1800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 257 510.000000 20036.1800 75.0000