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
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 418 226.750000 8435.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1435 6702.250000 250244.4000 37.3374
Subtotal (Total Children Is Unduplicated) 1649 6930.000000 258679.5000 37.3275
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 40 32.750000 1637.5000 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 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.500000 509.3200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 508.4300 78.2200
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 421.4700 76.6309
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 424.4600 77.1745
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 26.000000 1443.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.500000 804.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 24.000000 1829.9000 76.2458
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.500000 2029.3600 76.5796
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
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 102.9700 51.4850
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 18.000000 978.9800 54.3878
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 13.000000 735.3300 56.5638
Subtotal (Total Children Is Unduplicated) 113 207.250000 13204.3100 63.7120
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 53.750000 2687.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 134 172.500000 8625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 13.500000 337.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 58.500000 2900.0000 49.5726
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 18 23.750000 1187.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 28.500000 737.5000 25.8772
CONOF-CONOF-CONSULT, OT, FACE TO FACE 22 41.500000 2075.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 40 58.750000 2937.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 21 34.500000 862.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 38.750000 1937.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 39 104.000000 5200.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 24 45.750000 1168.7500 25.5464
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 67.000000 3350.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 49 132.500000 6625.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 27 41.500000 1062.5000 25.6024
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 80.500000 4236.0000 52.6211
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 21.750000 1147.5000 52.7586
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 32.000000 2592.8800 81.0275
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 13.000000 1057.1600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 4 49.500000 4025.3400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.000000 243.9600 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 2 12.000000 957.1200 79.7600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 19.000000 1479.5600 77.8716
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 397.2400 79.4480
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 11.750000 899.3500 76.5404
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 243.9600 81.3200
TRAV-TRAVS-Travel by mile 1 17.000000 7.5600 0.4447
Subtotal (Total Children Is Unduplicated) 285 1186.250000 59174.0200 49.8833
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Total 8323.500000 331057.8300 39.7739
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Number of Children (Unduplicated) With at Least One Service 1791
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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 0 0.000000 0.0000 0.0000
D 5 5.000000 200.0000 0.0000
S 15 14.250000 497.1500 0.0000
H 0 0.000000 0.0000 0.0000
T 3 19.000000 37.5600 37.5600
11830 8284.750000 330304.5200 0.0000
Other 1 0.500000 18.6000 0.0000
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Total 11854 8323.500000 331057.8300 37.5600