CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:OTHER
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 40 33.750000 1255.5000 37.2000
Subtotal (Total Children Is Unduplicated) 40 33.750000 1255.5000 37.2000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 7 11.000000 165.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 15 44.000000 635.0000 14.4318
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 24 58.000000 1043.9600 17.9993
-----------------------------------------------------------------------------------------------------------------------
Total 91.750000 2299.4600 25.0622
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 64
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 58 58.000000 1043.9600 1043.9600
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
0 0.000000 0.0000 0.0000
Other 84 33.750000 1255.5000 0.0000
---------------------------------------------------------
Total 142 91.750000 2299.4600 1043.9600