CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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 53 22.750000 846.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 396 863.000000 32103.6000 37.2000
Subtotal (Total Children Is Unduplicated) 426 886.750000 32949.9000 37.1580
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
EXIT-EXIT-COS Exit 69 72.000000 3625.0000 50.3472
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 83 97.000000 5233.1900 53.9504
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 91 97.750000 4894.5000 50.0716
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 126 147.750000 7425.0000 50.2538
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 27 24.500000 650.0000 26.5306
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 58 73.000000 3662.5000 50.1712
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 115 257.250000 12862.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 11 17.250000 431.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.500000 275.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 39 68.250000 3412.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 6.500000 162.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 18.000000 900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 47 76.000000 3800.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 9 7.750000 193.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 45 58.250000 2912.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 67 123.500000 6175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 10.750000 268.7500 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 108.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 97 543.500000 29349.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 35.250000 1903.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 193 1621.000000 24315.0000 15.0000
INTR-T1013-INTERPRETER 28 73.250000 3651.8000 49.8539
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 699 6394.000000 76728.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 32.000000 2602.2400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 6.000000 487.9200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 16 57.250000 4489.9800 78.4276
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 5 15.000000 1198.7200 79.9147
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 62.500000 5082.5000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 9.000000 731.8800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 7.000000 455.8400 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 3.000000 195.3600 65.1200
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 3.000000 47.2800 15.7600
TRAV-TRAVS-Travel by mile 213 24085.00000 10719.5900 0.4451
Subtotal (Total Children Is Unduplicated) 898 33944.75000 210417.6400 6.1988
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Total 34928.500000 248600.7300 7.1174
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Number of Children (Unduplicated) With at Least One Service 1019
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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 5328 11739.250000 98687.1300 98687.1300
D 134 395.750000 2665.3700 0.0000
S 7 8.000000 288.4500 0.0000
H 0 0.000000 0.0000 0.0000
T 6383 21681.750000 102631.5400 102524.9900
1558 1103.750000 44328.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13410 34928.500000 248600.7300 201212.1200