CMS/EIP Fiscal Report Center: 57
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: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 552 400.000000 14880.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 598 2252.250000 83783.7000 37.2000
Subtotal (Total Children Is Unduplicated) 923 2652.250000 98663.7000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 242.9400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 404.9000 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
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 6 10.500000 629.1600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1619.6000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 32.500000 2631.8500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 404.9000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 19.000000 1538.6200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 75.000000 4494.0000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 419.4400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 63 200.500000 13819.4000 68.9247
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.500000 75.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 80 81.000000 4050.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 30 30.000000 1500.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 145 145.000000 7250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 84 84.000000 4200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 481 3347.750000 180778.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 21.000000 1134.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 913 5796.000000 86940.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 375 2181.000000 26172.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 25.000000 2033.0000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 2 7.500000 609.9000 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 325.6000 65.1200
TRAV-TRAVS-Travel by mile 9 2757.000000 1226.8200 0.4450
Subtotal (Total Children Is Unduplicated) 1250 14489.75000 316788.7800 21.8630
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Total 17342.500000 429271.8800 24.7526
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Number of Children (Unduplicated) With at Least One Service 1586
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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 109 109.000000 3212.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.500000 18.6000 18.6000
T 7016 8461.250000 184026.9500 184026.9500
7183 8771.750000 242014.3300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14309 17342.500000 429271.8800 184045.5500