CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 685 321.250000 11950.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 850 2652.000000 98673.0000 37.2070
Subtotal (Total Children Is Unduplicated) 1198 2975.250000 110623.5000 37.1812
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 64 64.000000 3200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 11.500000 931.2700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 1.500000 121.4700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 13.000000 1052.7400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 4.500000 364.4100 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.000000 566.8600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 8.000000 479.3600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 4.000000 239.6800 59.9200
Subtotal (Total Children Is Unduplicated) 87 116.500000 7177.6700 61.6109
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 64 63.000000 3139.5000 49.8333
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 314 274.250000 13675.0000 49.8633
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 35 36.500000 875.0000 23.9726
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 5 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 5 5.000000 250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.750000 62.5000 35.7143
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 347 2297.750000 123283.5000 53.6540
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 76 305.000000 16456.5000 53.9557
EPIC-99601-Early Steps Professional Development Fee 465 3126.000000 46557.0000 14.8935
INTR-T1013-INTERPRETER 45 302.000000 20880.0000 69.1391
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 408 2607.000000 31047.0000 11.9091
OCCT-97530-OT SESSION BY LICENSED OT 4 12.000000 650.5600 54.2133
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 325.2800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 7.000000 439.5600 62.7943
PHY-97110HMGT-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 48.500000 3944.0200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 12.250000 996.1700 81.3200
Subtotal (Total Children Is Unduplicated) 1064 9112.500000 263124.3300 28.8751
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Total 12204.250000 380925.5000 31.2125
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Number of Children (Unduplicated) With at Least One Service 1626
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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 3980 4066.750000 116286.8500 116286.8500
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
10072 8096.500000 262850.7700 0.0000
Other 70 41.000000 1787.8800 0.0000
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Total 14122 12204.250000 380925.5000 116286.8500