CMS/EIP Fiscal Report Center: 03
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 316 216.000000 8016.6000 37.1139
TCM-T1017TL-TARGETED CASE MANAGEMENT 1062 2091.500000 77794.5000 37.1956
Subtotal (Total Children Is Unduplicated) 1146 2307.500000 85811.1000 37.1879
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 3 2.500000 125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 838.8800 59.9200
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 19 34.000000 2655.6200 78.1065
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 31.500000 2429.4000 77.1238
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 83 146.000000 8748.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
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 1 2.000000 161.9600 80.9800
SCREEN-T1023-SCREENING 6 6.000000 323.8800 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 172 361.500000 25306.4600 70.0040
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 14.750000 662.5000 44.9153
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 65 63.000000 3000.2500 47.6230
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 29.000000 1450.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 9.000000 450.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 23.000000 1150.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 12 17.000000 850.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 206 739.000000 39906.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 23 50.000000 2700.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 295 1052.000000 15780.0000 15.0000
INTR-T1013-INTERPRETER 14 29.000000 3360.0000 115.8621
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 287 869.000000 10428.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 76.000000 6180.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 10 39.250000 3191.8100 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 141.250000 10905.9000 77.2099
TRAV-TRAVS-Travel by mile 483 34747.00000 15459.2000 0.4449
Subtotal (Total Children Is Unduplicated) 578 37909.25000 116092.9400 3.0624
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Total 40578.250000 227210.5000 5.5993
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Number of Children (Unduplicated) With at Least One Service 1347
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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 334 1986.250000 7154.8500 7154.8500
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 0 0.000000 0.0000 0.0000
8368 38592.000000 220055.6500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8702 40578.250000 227210.5000 7154.8500