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
Payclass Filters:GR
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 684 505.000000 18786.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 56.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 984 3813.750000 141806.4000 37.1829
Subtotal (Total Children Is Unduplicated) 1229 4374.750000 160592.4000 36.7089
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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 22 20.000000 987.5000 49.3750
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 566.8600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 18.000000 1433.7200 79.6511
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 18 33.000000 1959.6800 59.3842
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 2.000000 115.4200 57.7100
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.500000 607.3500 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 36 63.500000 4855.1900 76.4597
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 94.500000 7208.2200 76.2775
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 443.6200 68.2492
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 211.500000 12083.0100 57.1301
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 570.4700 57.0470
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 5.000000 263.7500 52.7500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 2.000000 109.5200 54.7600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 8 33.000000 1850.6300 56.0797
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 6.000000 335.2600 55.8767
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 225.7400 56.4350
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 15.000000 818.0500 54.5367
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4400 51.4400
Subtotal (Total Children Is Unduplicated) 257 562.500000 35984.2600 63.9720
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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 228 271.750000 13160.3500 48.4282
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 263 323.750000 15452.0400 47.7283
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.000000 175.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 25.000000 1212.5000 48.5000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 69 176.000000 8800.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 38 83.000000 4150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 55 123.750000 6187.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 7 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 101 241.250000 12062.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 33 86.000000 4300.0000 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 311 3608.750000 189753.4600 52.5815
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 81 260.500000 13764.0000 52.8369
EPIC-99601-Early Steps Professional Development Fee 456 4970.000000 74214.0000 14.9324
INTR-T1013-INTERPRETER 21 131.250000 9447.5000 71.9810
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 517 5594.000000 67104.0000 11.9957
OCCT-97530-OT SESSION BY LICENSED OT 29 252.000000 19659.6000 78.0143
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 10.000000 794.4800 79.4480
OCCT-97530GT-OT SESSION BY LICENSED OT 3 25.000000 1958.1200 78.3248
PHY-97110-PT SESSION BY LICENSED PT 37 312.750000 24541.2900 78.4694
PHY-97110GT-PT SESSION BY LICENSED PT 10 11.000000 810.2800 73.6618
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 493.500000 38611.9500 78.2410
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 5.750000 441.8500 76.8435
TRAV-TRAVS-Travel by mile 685 162865.0000 72429.5400 0.4447
Subtotal (Total Children Is Unduplicated) 877 179922.5000 579892.5200 3.2230
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Total 184859.750000 776469.1800 4.2003
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Number of Children (Unduplicated) With at Least One Service 1472
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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 22803 156098.500000 526056.8800 526056.8800
D 0 0.000000 0.0000 0.0000
S 10 24.000000 198.7600 198.7600
H 326 1744.000000 7148.4800 7148.4800
T 1461 1036.250000 38718.7100 38718.7100
9335 25957.000000 204346.3500 25.0000
Other 0 0.000000 0.0000 0.0000
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Total 33935 184859.750000 776469.1800 572147.8300