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
Payclass Filters:TPIN
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 3 2.500000 93.0000 37.2000
Subtotal (Total Children Is Unduplicated) 3 2.500000 93.0000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-COS Exit 22 20.750000 1037.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 12.500000 994.3100 79.5448
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 24 39.000000 2303.7300 59.0700
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.500000 431.7200 57.5627
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 14 25.000000 2024.5000 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 43.500000 3319.2800 76.3053
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 23.000000 1757.8900 76.4300
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 805.4400 76.7086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 13.500000 1039.4100 76.9933
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 18.500000 1408.4300 76.1314
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 15.000000 1169.8500 77.9900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 98 176.000000 9971.3200 56.6552
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 31 56.000000 3173.4200 56.6682
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 106.000000 8129.2700 76.6912
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 65.500000 5023.1300 76.6890
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 160.9300 53.6433
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 6 6.000000 335.2600 55.8767
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 619.1100 56.2827
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 9 88.000000 5931.8200 67.4070
Subtotal (Total Children Is Unduplicated) 259 765.250000 51163.2700 66.8582
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 3.500000 175.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 610 9487.750000 499616.0000 52.6591
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 143 893.500000 46923.0000 52.5159
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
INTR-T1013-INTERPRETER 2 2.500000 125.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 4.000000 48.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 41 580.750000 46101.6300 79.3829
OCCT-97530GO-OT SESSION BY LICENSED OT 2 8.000000 650.5600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 5.000000 397.2400 79.4480
OCCT-97530GT-OT SESSION BY LICENSED OT 13 55.000000 4285.4000 77.9164
PHY-97110-PT SESSION BY LICENSED PT 78 1293.000000 101039.2400 78.1433
PHY-97110GT-PT SESSION BY LICENSED PT 17 72.750000 5732.6900 78.7999
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 139 2100.250000 164218.4100 78.1899
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 147.000000 11472.0000 78.0408
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 22.000000 1432.6400 65.1200
SPL-92508HA-GROUP SPL SESSION PER CHILD 3 19.000000 292.2400 15.3811
Subtotal (Total Children Is Unduplicated) 737 14710.50000 883147.5500 60.0352
-----------------------------------------------------------------------------------------------------------------------
Total 15478.250000 934403.8200 60.3688
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 795
-----------------------------------------------------------------------------------------------------------------------
Center 01
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 12440 12470.000000 737406.8400 737268.8400
D 218 217.250000 14502.3200 0.0000
S 4 4.000000 293.9600 0.0000
H 1064 1216.750000 81703.4100 0.0000
T 1168 1165.750000 71617.3100 69506.9300
374 404.500000 28879.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15268 15478.250000 934403.8200 806775.7700