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
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 108 55.500000 2064.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 259 413.500000 15382.2000 37.2000
Subtotal (Total Children Is Unduplicated) 311 469.000000 17446.8000 37.2000
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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 5 10.000000 599.2000 59.9200
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 2 2.500000 202.4500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 3.000000 121.4700 40.4900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.500000 569.2400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 28 54.500000 3721.4700 68.2839
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 13.000000 575.0000 44.2308
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 48 46.500000 2262.5000 48.6559
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 20.000000 1000.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 7.000000 350.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 16.000000 800.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 10 14.000000 700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 93 302.000000 16308.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 10 16.000000 864.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 163 571.000000 8565.0000 15.0000
INTR-T1013-INTERPRETER 2 8.000000 612.5000 76.5625
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 156 448.000000 5376.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 35.000000 2846.2000 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 9 32.000000 2602.2400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 31.250000 2541.2500 81.3200
TRAV-TRAVS-Travel by mile 260 18637.00000 8291.9100 0.4449
Subtotal (Total Children Is Unduplicated) 306 20207.75000 54313.5600 2.6878
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Total 20731.250000 75481.8300 3.6410
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Number of Children (Unduplicated) With at Least One Service 482
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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 174 1075.750000 3409.0000 3409.0000
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 0 0.000000 0.0000 0.0000
3355 19655.500000 72072.8300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3529 20731.250000 75481.8300 3409.0000