CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
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 756 421.500000 15698.4000 37.2441
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 6.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 810 2406.000000 89503.2000 37.2000
Subtotal (Total Children Is Unduplicated) 1213 2834.250000 105201.6000 37.1180
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 121 93.750000 4643.7500 49.5333
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 129 119.750000 6365.4100 53.1558
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 80 91.750000 4325.0000 47.1390
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 91 114.750000 5512.5000 48.0392
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 59 54.750000 1337.5000 24.4292
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 7 11.000000 550.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 6 7.500000 375.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.500000 325.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 7 8.000000 400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 405 3223.500000 159129.0000 49.3653
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 92 396.500000 19212.5000 48.4552
EPIC-99601-Early Steps Professional Development Fee 509 4062.000000 60375.0000 14.8634
INTR-T1013-INTERPRETER 37 330.250000 20595.0000 62.3618
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 496 3755.000000 44907.0000 11.9593
OCCT-97530-OT SESSION BY LICENSED OT 3 18.500000 899.5000 48.6216
OCCT-97530GT-OT SESSION BY LICENSED OT 1 0.500000 35.9800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 7.000000 172.8000 24.6857
OCCT-97530HMGT-OT SESSION BY OT ASST 2 9.000000 518.4000 57.6000
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 100.7300 50.3650
PHY-97110HMGT-PT SESSION BY PT ASST 1 6.500000 374.1400 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 67.500000 4871.3400 72.1680
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 19.750000 1465.6700 74.2111
Subtotal (Total Children Is Unduplicated) 1066 12207.75000 326032.0600 26.7070
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Total 15161.750000 437599.0700 28.8620
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Number of Children (Unduplicated) With at Least One Service 1659
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Center 06
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 12069 12226.000000 326313.5800 326313.5800
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 0 0.000000 0.0000 0.0000
4603 2843.500000 107853.7900 0.0000
Other 187 92.250000 3431.7000 0.0000
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Total 16859 15161.750000 437599.0700 326313.5800