CMS/EIP Fiscal Report Center: 02
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
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 13 13.000000 650.0000 50.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 16 17.000000 928.1800 54.5988
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 14 17.500000 875.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 8 8.750000 437.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 15.000000 750.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 18 18.500000 925.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 7 5.000000 250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 6 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 54 283.000000 15282.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 20.500000 1107.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 142 926.000000 13890.0000 15.0000
INTR-T1013-INTERPRETER 8 23.750000 1187.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 45 264.000000 3168.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 51.500000 4187.9800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 1 8.250000 670.8900 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 19.750000 1606.0700 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
TRAV-TRAVS-Travel by mile 30 1528.000000 679.7500 0.4449
Subtotal (Total Children Is Unduplicated) 195 3201.500000 45773.2900 14.2975
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Total 3218.500000 46701.4700 14.5103
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Number of Children (Unduplicated) With at Least One Service 198
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Center 02
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1120 2357.500000 29627.1800 29526.5400
648 861.000000 17074.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1768 3218.500000 46701.4700 29526.5400