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:Program Patients
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
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-COS Exit 23 21.750000 1087.5000 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 2 3.500000 271.4700 77.5629
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 236.9600 78.9867
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 28 45.500000 2686.5800 59.0457
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 551.5600 58.0589
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 28 49.000000 3737.7600 76.2808
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 30.500000 2256.2300 73.9748
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 13.000000 992.9400 76.3800
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 13 23.000000 1745.9300 75.9100
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 20.000000 1553.8200 77.6910
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 122 217.000000 12291.0200 56.6406
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 76.000000 4325.4100 56.9133
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 126.000000 9662.1600 76.6838
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 85.500000 6550.0400 76.6087
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) 312 907.750000 60610.2000 66.7697
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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 611 9495.750000 500036.0000 52.6589
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 144 910.500000 47825.0000 52.5261
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 42 608.750000 48294.3500 79.3336
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 141 2163.250000 169247.9700 78.2378
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) 740 14826.50000 891691.8300 60.1418
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Total 15736.750000 952395.0300 60.5204
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Number of Children (Unduplicated) With at Least One Service 850
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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 12564 12616.000000 747407.0200 747269.0200
D 219 219.250000 14652.3200 0.0000
S 4 4.000000 293.9600 0.0000
H 1139 1317.250000 88828.6700 0.0000
T 1169 1167.750000 71737.1500 69626.7700
379 412.500000 29475.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15474 15736.750000 952395.0300 816895.7900