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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 181 81.250000 3022.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2865 7938.000000 295202.6000 37.1885
Subtotal (Total Children Is Unduplicated) 2893 8020.250000 298225.1000 37.1840
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 13.000000 630.5000 48.5000
EXIT-EXIT-COS Exit 86 91.500000 4562.5000 49.8634
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 404.9000 89.9778
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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 17 28.000000 1677.7600 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 20 36.500000 2955.7700 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 67.000000 5366.5200 80.0973
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 35.000000 2711.6600 77.4760
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 20.000000 1619.6000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 16.500000 1336.1700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 59.000000 4777.8200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 25.500000 2064.9900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 240 411.500000 24657.0800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 73 132.000000 7950.6800 60.2324
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 198 360.500000 29193.2900 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 92 174.000000 13886.9500 79.8101
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 406.7700 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 8.000000 464.8800 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 663 1520.000000 106698.1000 70.1961
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 128 134.750000 6744.5000 50.0519
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 173 196.500000 9887.5000 50.3181
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 52 45.750000 1182.2500 25.8415
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 89 113.250000 5677.0000 50.1280
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 171 351.000000 17505.0000 49.8718
CONIP-CONIP-CONSULT, ITDS PHONE 16 23.250000 581.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 17.750000 887.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 57 100.500000 5025.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 10 9.000000 225.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 22 30.000000 1500.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 68 106.750000 5337.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 10 8.250000 206.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 61 78.250000 3912.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 89 152.750000 7637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 18.750000 468.7500 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 679 5062.250000 273286.0000 53.9851
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 79 251.000000 13554.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 351 2704.000000 40560.0000 15.0000
INTR-T1013-INTERPRETER 144 318.500000 16100.4500 50.5509
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1537 12353.00000 148236.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 50 281.750000 22765.9100 80.8018
OCCT-97530GO-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 1.500000 121.9800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 10 33.000000 2683.5600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 81 580.250000 46829.8600 80.7064
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 13 38.750000 3130.0700 80.7760
PHY-97110TL-PT SESSION BY LICENSED PT 2 10.000000 813.2000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 102 672.000000 54414.8900 80.9745
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 36.000000 2927.5200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 24.000000 1562.8800 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 3.000000 195.3600 65.1200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 406.6000 81.3200
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 9.000000 141.8400 15.7600
TRAV-TRAVS-Travel by mile 518 50210.00000 22367.1500 0.4455
Subtotal (Total Children Is Unduplicated) 2039 73988.50000 717552.0100 9.6982
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Total 83528.750000 1122475.2100 13.4382
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Number of Children (Unduplicated) With at Least One Service 3285
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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 11591 23944.000000 310962.7600 310962.7600
D 405 1110.250000 14915.3100 0.0000
S 2422 2356.500000 122121.3900 0.0000
H 4817 3902.500000 165192.7900 124146.7800
T 15156 48352.750000 354929.4500 352240.0800
5291 3848.750000 153832.7100 0.0000
Other 29 13.000000 483.6000 0.0000
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Total 39714 83528.750000 1122475.2100 787349.6200