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
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
EXIT-EXIT-COS Exit 4 3.250000 162.5000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
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-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 8 10.250000 664.3700 64.8166
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.500000 225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 31 35.000000 1750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 6.000000 300.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.500000 75.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 10.000000 250.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.500000 275.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 9 10.250000 512.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 6.500000 162.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 16 23.500000 1175.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 6.750000 168.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 3.750000 187.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 14 26.000000 1300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 9.750000 243.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 12.500000 675.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 4.250000 229.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 17.000000 1382.4400 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 1 6.250000 508.2500 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 1 17.000000 7.5600 0.4447
Subtotal (Total Children Is Unduplicated) 83 230.750000 10984.9800 47.6055
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Total 1127.750000 44599.2500 39.5471
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Number of Children (Unduplicated) With at Least One Service 482
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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 0 0.000000 0.0000 0.0000
S 7 8.000000 288.4500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 17.000000 7.5600 7.5600
1557 1102.750000 44303.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1565 1127.750000 44599.2500 7.5600