CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2111 2899.250000 107852.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2978 20268.75000 753997.5000 37.2000
Subtotal (Total Children Is Unduplicated) 3012 23168.00000 861849.6000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 49 39.500000 1975.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 22.000000 1760.6300 80.0286
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 60 76.500000 6066.4000 79.2993
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.500000 520.3900 80.0600
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 22 26.500000 2110.0900 79.6260
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 17 22.000000 1300.5600 59.1164
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 55 89.500000 5281.0700 59.0064
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.000000 971.7600 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 14 17.000000 1376.6600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 172.000000 13626.5700 79.2242
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 570 748.500000 59447.4300 79.4221
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 61 65.000000 5191.9400 79.8760
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 308 387.500000 30711.3600 79.2551
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 225.000000 13294.1500 59.0851
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 796 1344.000000 78927.7700 58.7260
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 150 243.000000 19328.3100 79.5404
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 515 840.500000 66582.0200 79.2172
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 304.0000 304.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 219 219.000000 27362.8000 124.9443
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 109.5200 54.7600
OCTH-97165-OT EVAL LOW COMPLEXITY 70 86.000000 4852.7100 56.4269
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 489.4900 54.3878
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 5 8.000000 458.1800 57.2725
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 52 66.000000 3674.0100 55.6668
PSTH-97161GT-PT EVAL LOW COMPLEXITY 4 6.000000 341.9600 56.9933
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 6.000000 348.6600 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 502.8900 55.8767
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 5 5.000000 283.8500 56.7700
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 4 4.000000 205.6400 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 64 78.000000 4371.7800 56.0485
SPCH-92521TL-EVAL OF SPEECH FLUENCY 7 7.000000 379.9700 54.2814
SPCH-92522-EVAL OF SPCH SOUND PROD 7 7.000000 400.0700 57.1529
SPCH-92522TL-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 1352 4859.000000 353080.6300 72.6653
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 72 247.500000 12375.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 5.000000 250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 8 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 155 10492.50000 280973.5000 26.7785
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1848 43101.50000 2282340.2000 52.9527
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 40 277.000000 14724.0000 53.1552
EPIC-99601-Early Steps Professional Development Fee 1551 36505.00000 547575.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 485 8079.000000 96948.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 115 1173.000000 92116.9500 78.5311
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 153.2800 76.6400
OCCT-97530HM-OT SESSION BY OT ASST 87 912.500000 58358.6400 63.9547
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 113 1117.000000 89247.6800 79.8994
PHY-97110HM-PT SESSION BY PT ASST 62 737.500000 46782.6000 63.4340
PHY-97110TL-PT SESSION BY LICENSED PT 2 16.000000 1254.3200 78.3950
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 152 1504.000000 120540.9200 80.1469
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 123.000000 8009.7600 65.1200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 2082 104318.5000 3653056.4100 35.0183
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Total 132345.500000 4867986.6400 36.7824
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Number of Children (Unduplicated) With at Least One Service 3205
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Center 04
Flag Claims Units Chgs Paid
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R 192 292.250000 10871.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 3465 5387.750000 228898.8200 0.0000
P 63735 66137.750000 1708161.2000 1664559.5400
D 152 238.500000 10504.9400 0.0000
S 6 14.750000 548.7000 0.0000
H 34207 33915.000000 1819660.7400 837.0000
T 2 4.000000 148.8000 0.0000
19147 25339.000000 1012996.0200 90.0000
Other 1715 1016.500000 76195.7200 -335.0000
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Total 122621 132345.500000 4867986.6400 1665151.5400