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
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 1639 1860.500000 69201.3000 37.1950
TCM-T1017TL-TARGETED CASE MANAGEMENT 2979 24220.75000 901542.0000 37.2219
Subtotal (Total Children Is Unduplicated) 2995 26081.25000 970743.3000 37.2200
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 11 29.500000 1475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 35.000000 2792.4400 79.7840
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 10.000000 776.9100 77.6910
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 43 73.500000 5874.2900 79.9223
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 13.500000 1060.3400 78.5437
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 30.500000 2439.9900 79.9997
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 78 136.500000 8106.2800 59.3867
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 25.000000 1460.4300 58.4172
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 381 645.500000 50986.8900 78.9882
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 34 56.000000 4391.3600 78.4171
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 514 852.500000 67788.6200 79.5174
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 48 74.500000 5835.6700 78.3311
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 283 469.500000 37425.1000 79.7127
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 58.500000 4590.8200 78.4756
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1037 1799.500000 105884.8800 58.8413
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 104 165.000000 9546.4600 57.8573
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 99.000000 7685.0000 77.6263
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 13.500000 1075.2900 79.6511
Subtotal (Total Children Is Unduplicated) 1397 4588.500000 319317.2400 69.5908
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 12.000000 600.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 7 11.000000 550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 28.000000 1512.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 270.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
Subtotal (Total Children Is Unduplicated) 15 59.000000 3012.0000 51.0508
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Total 30728.750000 1293072.5400 42.0802
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Number of Children (Unduplicated) With at Least One Service 2996
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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 1 2.000000 74.4000 0.0000
P 0 0.000000 0.0000 0.0000
D 3 3.000000 80.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12094 18241.500000 795126.1400 793945.0400
T 0 0.000000 0.0000 0.0000
11788 12426.750000 495727.4000 18.6000
Other 58 55.500000 2064.6000 0.0000
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Total 23944 30728.750000 1293072.5400 793963.6400