CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 75 40.000000 1488.0000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 708 3792.000000 141034.5000 37.1926
Subtotal (Total Children Is Unduplicated) 710 3832.000000 142522.5000 37.1927
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 3 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 323.9200 92.5486
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 391.3300 71.1509
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 722.8400 80.3156
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 433.4300 78.8055
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 12 18.500000 1090.8400 58.9643
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.000000 419.4400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 242.9400 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 72.500000 5793.3100 79.9077
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 41 67.000000 5013.8900 74.8342
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 35.000000 2783.4700 79.5277
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 32.500000 2601.9500 80.0600
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 70.000000 5617.7700 80.2539
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 25 41.000000 3263.0500 79.5866
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 268 400.000000 23583.2100 58.9580
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 93 145.500000 8587.9700 59.0238
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 198 316.000000 25251.8100 79.9108
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 103 170.000000 13445.3000 79.0900
Subtotal (Total Children Is Unduplicated) 614 1404.500000 99716.4700 70.9978
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 3 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 3.000000 150.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 29.000000 1554.0000 53.5862
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 17.000000 902.0000 53.0588
EPIC-99601-Early Steps Professional Development Fee 3 18.000000 270.0000 15.0000
INTR-T1013-INTERPRETER 84 145.500000 7286.1000 50.0763
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9 208.000000 2496.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 35.000000 2761.9600 78.9131
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 71.000000 5680.1200 80.0017
TRAV-TRAVS-Travel by mile 71 1932.000000 861.4300 0.4459
Subtotal (Total Children Is Unduplicated) 149 2472.000000 22636.6100 9.1572
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Total 7708.500000 264875.5800 34.3615
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Number of Children (Unduplicated) With at Least One Service 717
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Center 01
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 713 2284.750000 36578.2000 36578.2000
D 24 217.500000 1208.1100 0.0000
S 242 285.750000 16393.4200 0.0000
H 3119 2843.750000 134674.0200 109864.8000
T 60 266.750000 4165.7600 4044.2900
2169 1780.250000 70749.3700 0.0000
Other 47 29.750000 1106.7000 0.0000
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Total 6374 7708.500000 264875.5800 150487.2900