CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2024 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 1297 1075.500000 39990.0000 37.1827
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 69.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2766 11939.75000 443926.2000 37.1805
Subtotal (Total Children Is Unduplicated) 2915 13084.25000 483916.2000 36.9846
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
EXIT-EXIT-COS Exit 23 20.500000 1012.5000 49.3902
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 35.500000 2774.0400 78.1420
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 33.000000 2520.1400 76.3679
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 455.4100 60.7213
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 25 46.000000 2729.8000 59.3435
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 4.000000 226.4200 56.6050
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 10 16.500000 1336.1700 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 316 575.000000 42561.0900 74.0193
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.000000 79.6000 39.8000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 337 627.000000 48563.2900 77.4534
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 68.500000 4779.2200 69.7696
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 446 844.000000 49631.2700 58.8048
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 31.500000 1858.7500 59.0079
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 50 92.000000 7450.1600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 6.000000 315.1600 52.5267
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 110.4400 36.8133
PSTH-97161-PT EVAL LOW COMPLEXITY 8 9.000000 509.5900 56.6211
PSTH-97162-PT EVAL MODERATE COMPLEXITY 15 40.000000 2151.0400 53.7760
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 7.000000 393.3700 56.1957
SCREEN-T1023-SCREENING 26 29.000000 1549.5000 53.4310
SPCH-92521-EVAL OF SPEECH FLUENCY 8 8.000000 451.4800 56.4350
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 37 42.000000 2291.7200 54.5648
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4400 51.4400
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 8.000000 411.2800 51.4100
Subtotal (Total Children Is Unduplicated) 976 2578.000000 175561.2600 68.0998
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 187.5600 93.7800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 243 283.000000 13635.3500 48.1814
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 293 353.500000 16814.7900 47.5666
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 7.500000 187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 29.000000 1412.5000 48.7069
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 78 189.000000 9450.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 41 90.000000 4500.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 57 129.750000 6487.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 7 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 112 257.250000 12862.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 37 93.000000 4650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.500000 75.0000 30.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 5 28.000000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 454 4719.250000 249720.4600 52.9153
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 106 342.500000 18172.0000 53.0569
EPIC-99601-Early Steps Professional Development Fee 602 5990.000000 89514.0000 14.9439
INTR-T1013-INTERPRETER 54 191.000000 15362.5000 80.4319
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 691 6796.000000 81528.0000 11.9965
OCCT-97530-OT SESSION BY LICENSED OT 61 509.750000 38266.0400 75.0682
OCCT-97530GOGT-OT SESSION BY LICENSED OT 4 11.000000 875.8000 79.6182
OCCT-97530GT-OT SESSION BY LICENSED OT 4 26.000000 2030.0800 78.0800
PHY-97110-PT SESSION BY LICENSED PT 71 659.750000 49178.7800 74.5415
PHY-97110GT-PT SESSION BY LICENSED PT 18 22.250000 1638.0100 73.6184
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 132 1329.000000 98702.3800 74.2682
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 9.750000 748.4100 76.7600
TRAV-TRAVS-Travel by mile 938 200215.0000 89046.1100 0.4448
Subtotal (Total Children Is Unduplicated) 1227 222298.7500 805645.2700 3.6242
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Total 237961.000000 1465122.7300 6.1570
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Number of Children (Unduplicated) With at Least One Service 2975
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Center 03
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 27662 180616.500000 749219.4300 749219.4300
D 0 0.000000 0.0000 0.0000
S 10 24.000000 198.7600 198.7600
H 485 2550.250000 13603.0300 13603.0300
T 1544 1105.250000 41312.9600 41312.9600
24446 53665.000000 660788.5500 25.0000
Other 0 0.000000 0.0000 0.0000
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Total 54147 237961.000000 1465122.7300 804359.1800