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
Payclass Filters:GR
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 878 985.000000 36632.7000 37.1906
TCM-T1017TL-TARGETED CASE MANAGEMENT 610 4072.750000 152036.4000 37.3302
Subtotal (Total Children Is Unduplicated) 1139 5057.750000 188669.1000 37.3030
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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 3 4.500000 352.4500 78.3222
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.000000 701.9100 77.9900
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 271.4700 77.5629
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 10 17.000000 987.7000 58.1000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.000000 284.1300 56.8260
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.500000 1021.4700 75.6644
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 805.4400 76.7086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 892.4000 77.6000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 233.9700 77.9900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 36.000000 2033.3600 56.4822
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 173.1300 57.7100
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 48 153.000000 9787.3300 63.9695
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 7.000000 350.0000 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
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
Subtotal (Total Children Is Unduplicated) 11 21.000000 980.0000 46.6667
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Total 5231.750000 199436.4300 38.1204
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Number of Children (Unduplicated) With at Least One Service 1144
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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 3 3.000000 80.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 10.500000 390.6000 390.6000
T 0 0.000000 0.0000 0.0000
5716 5218.250000 198965.8300 18.6000
Other 0 0.000000 0.0000 0.0000
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Total 5727 5231.750000 199436.4300 409.2000