CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 33.000000 1227.6000 37.2000
Subtotal (Total Children Is Unduplicated) 26 33.000000 1227.6000 37.2000
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Screening, Eval, and Assessment,Class #02
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 1 1.000000 58.1100 58.1100
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 31.000000 1550.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 237 1608.000000 86832.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 6.750000 364.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 763 4871.000000 73065.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 180 1170.000000 14040.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 6.500000 528.5800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 5 14.500000 1179.1400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 8.000000 520.9600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 11.500000 935.1800 81.3200
Subtotal (Total Children Is Unduplicated) 959 7729.250000 179115.3600 23.1737
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Total 7763.250000 180401.0700 23.2378
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Number of Children (Unduplicated) With at Least One Service 977
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Center 04
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 7754 7708.500000 178703.9700 178703.9700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 19.000000 363.0000 363.0000
T 0 0.000000 0.0000 0.0000
56 33.750000 1265.1000 0.0000
Other 2 2.000000 69.0000 69.0000
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Total 7831 7763.250000 180401.0700 179135.9700