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
Agency Filter:EXT
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 18 11.000000 409.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 231 697.500000 25947.0000 37.2000
Subtotal (Total Children Is Unduplicated) 233 708.500000 26356.2000 37.2000
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Screening, Eval, and Assessment,Class #02
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) 194 302.000000 16941.7200 56.0984
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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 1847 43100.50000 2282286.2000 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 484 8078.000000 96936.0000 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) 2081 104316.5000 3652990.4100 35.0183
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Total 105327.000000 3696288.3300 35.0935
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Number of Children (Unduplicated) With at Least One Service 2147
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Center 04
Flag Claims Units Chgs Paid
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R 60 67.250000 2501.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 190 169.250000 6296.1000 0.0000
P 58711 57415.500000 1351063.7200 1298599.2400
D 0 0.000000 0.0000 0.0000
S 1 3.000000 111.6000 0.0000
H 34206 33914.000000 1819606.7400 837.0000
T 0 0.000000 0.0000 0.0000
8578 12749.500000 440810.3500 90.0000
Other 1709 1008.500000 75898.1200 -335.0000
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Total 103455 105327.000000 3696288.3300 1299191.2400