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
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
EXIT-EXIT-COS Exit 65 68.750000 3462.5000 50.3636
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
OCTH-97165-OT EVAL LOW 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) 78 86.750000 4568.8200 52.6665
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 88 93.250000 4669.5000 50.0751
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 99 112.750000 5675.0000 50.3326
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 19.750000 531.2500 26.8987
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 54 67.000000 3362.5000 50.1866
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 113 255.750000 12787.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 7.250000 181.2500 25.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 30 58.000000 2900.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 12.000000 600.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 31 52.500000 2625.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 54.500000 2725.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 53 97.500000 4875.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 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 95 531.000000 28674.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 31.000000 1674.0000 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 6 15.000000 1219.8000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 15 51.000000 3981.7300 78.0731
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 4 13.000000 1036.0800 79.6985
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 58.500000 4757.2200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 650.5600 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 24068.00000 10712.0300 0.4451
Subtotal (Total Children Is Unduplicated) 867 33714.00000 199432.6600 5.9154
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Total 33800.750000 204001.4800 6.0354
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Number of Children (Unduplicated) With at Least One Service 872
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6382 21664.750000 102623.9800 102517.4300
1 1.000000 25.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11845 33800.750000 204001.4800 201204.5600