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
Agency Filter:EIP DEI DEIP
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 770 392.500000 14601.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 5946 31790.50000 1183101.5000 37.2156
Subtotal (Total Children Is Unduplicated) 5977 32184.00000 1197702.5000 37.2142
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 52 44.000000 2200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 39.000000 3128.3200 80.2133
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.000000 701.9100 77.9900
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 56 90.000000 5308.8200 58.9869
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 10.000000 592.5700 59.2570
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 33 60.500000 4899.2900 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 169 300.500000 23862.0700 79.4079
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 48 85.000000 6760.7100 79.5378
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 63 100.500000 7956.1000 79.1652
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 63 105.000000 8317.5200 79.2145
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 74 135.500000 10778.4400 79.5457
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 54 95.500000 7587.0800 79.4459
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 606 1036.500000 61185.5100 59.0309
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 182 323.500000 19032.7300 58.8338
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 602 1054.000000 84046.2900 79.7403
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 390 705.500000 56072.9300 79.4797
OCTH-97165-OT EVAL LOW COMPLEXITY 3 4.000000 232.4400 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 348.6600 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 161.0800 53.6933
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 13 75.000000 4184.0500 55.7873
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 10 58.000000 3296.6800 56.8393
Subtotal (Total Children Is Unduplicated) 1919 4357.000000 311840.2000 71.5722
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 56 60.250000 3012.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 150 188.500000 9425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 16.750000 418.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 20 65.500000 3250.0000 49.6183
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 20 25.500000 1275.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 12 33.500000 862.5000 25.7463
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 50.750000 2537.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 51 83.750000 4187.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 23 36.500000 912.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 42.750000 2137.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 50 118.000000 5900.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 26 49.500000 1262.5000 25.5051
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 40 73.000000 3650.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 58 141.500000 7075.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 31 49.500000 1262.5000 25.5051
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 136 1440.250000 76520.0000 53.1297
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 56 175.750000 9315.5000 53.0043
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 39 357.500000 28772.3800 80.4822
OCCT-97530GO-OT SESSION BY LICENSED OT 4 13.000000 1057.1600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 4 4.500000 356.5800 79.2400
OCCT-97530GT-OT SESSION BY LICENSED OT 12 58.000000 4679.1200 80.6745
OCCT-97530TL-OT SESSION BY LICENSED OT 13 91.000000 7035.0800 77.3086
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 24.000000 1876.8000 78.2000
PHY-97110-PT SESSION BY LICENSED PT 37 326.750000 26346.6700 80.6325
PHY-97110GT-PT SESSION BY LICENSED PT 14 71.250000 5765.9700 80.9259
PHY-97110TL-PT SESSION BY LICENSED PT 18 137.500000 10935.8000 79.5331
PHY-97110TLGT-PT SESSION BY LICENSED PT 7 15.000000 1154.2800 76.9520
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 437.750000 35066.6500 80.1066
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 42.000000 3368.6400 80.2057
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 12 63.500000 4932.1600 77.6718
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 315.9200 78.9800
TRAV-TRAVS-Travel by mile 1 17.000000 7.5600 0.4447
Subtotal (Total Children Is Unduplicated) 442 4316.000000 264705.0200 61.3311
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Total 40857.000000 1774247.7200 43.4258
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Number of Children (Unduplicated) With at Least One Service 5984
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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 4 1.500000 55.8000 0.0000
P 0 0.000000 0.0000 0.0000
D 10 11.750000 600.2600 0.0000
S 2359 2249.750000 115392.6300 0.0000
H 27160 21913.500000 983349.3200 835263.7600
T 3 19.000000 37.5600 37.5600
23333 16588.250000 672087.2500 65.1000
Other 152 73.250000 2724.9000 0.0000
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Total 53021 40857.000000 1774247.7200 835366.4200