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: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 163 73.250000 2724.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2619 6977.500000 259472.0000 37.1870
Subtotal (Total Children Is Unduplicated) 2640 7051.750000 262196.9000 37.1818
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 9 7.750000 387.5000 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 1.500000 121.4700 80.9800
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 13 21.500000 1288.2800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 16 29.500000 2388.9100 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 48.000000 3887.0400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 7.000000 566.8600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 10.500000 850.2900 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 850.2900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 30.500000 2469.8900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 16.500000 1336.1700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 125 228.000000 13661.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 40.500000 2426.7600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 126 225.500000 18260.9900 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 101.000000 8178.9800 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 4.000000 232.4400 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 353 800.750000 58103.3500 72.5612
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 7.500000 375.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 36 39.000000 1950.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 5.750000 143.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 8.000000 400.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 2.250000 112.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 12.000000 300.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 7.750000 387.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 16 28.250000 1412.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 8.500000 212.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 8.000000 400.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 21 29.000000 1450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 9 7.250000 181.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.750000 437.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 20 32.000000 1600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 11 15.750000 393.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 51 344.750000 18603.0000 53.9608
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 31.750000 1714.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 146.500000 11913.3800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 1.500000 121.9800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 25.000000 2033.0000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 22 106.000000 8619.9200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 6 21.000000 1707.7200 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 2 10.000000 813.2000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 106.000000 8619.9200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 11.000000 894.5200 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 406.6000 81.3200
TRAV-TRAVS-Travel by mile 1 17.000000 7.5600 0.4447
Subtotal (Total Children Is Unduplicated) 188 1048.250000 65455.5100 62.4427
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Total 8900.750000 385755.7600 43.3397
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Number of Children (Unduplicated) With at Least One Service 2685
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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 3 1.000000 37.2000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2186 2074.250000 105734.7000 0.0000
H 4288 3409.250000 143532.9200 108959.8800
T 1 17.000000 7.5600 7.5600
4748 3394.000000 136248.0800 0.0000
Other 14 5.250000 195.3000 0.0000
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Total 11240 8900.750000 385755.7600 108967.4400