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
Payclass Filters:GR
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 13 7.250000 269.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 47 142.000000 5282.4000 37.2000
Subtotal (Total Children Is Unduplicated) 58 149.250000 5552.1000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTH-97165-OT EVAL LOW COMPLEXITY 5 6.000000 348.6600 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 7 9.000000 509.5900 56.6211
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 10 20.000000 1148.8000 57.4400
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 54 202.250000 10112.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 5.000000 250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 326 7608.000000 399400.0000 52.4974
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 42.000000 2170.0000 51.6667
EPIC-99601-Early Steps Professional Development Fee 986 26845.00000 402675.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 318 6084.000000 73008.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 103.500000 8117.1000 78.4261
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 9 133.500000 10472.4600 78.4454
PHY-97110HM-PT SESSION BY PT ASST 2 34.000000 2130.9200 62.6741
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 77.000000 6018.2800 78.1595
Subtotal (Total Children Is Unduplicated) 1224 41152.25000 915261.8600 22.2409
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Total 41321.500000 921962.7600 22.3119
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Number of Children (Unduplicated) With at Least One Service 1265
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Center 04
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 41471 41111.750000 914239.7900 914215.7900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 28 28.000000 577.1100 507.0000
T 0 0.000000 0.0000 0.0000
182 153.250000 5612.1000 60.0000
Other 38 28.500000 1533.7600 -275.0000
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Total 41719 41321.500000 921962.7600 914507.7900