CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2025 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 632 705.500000 26244.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1189 4830.750000 179703.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1226 5536.250000 205948.5000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 10 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.500000 688.3300 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 13.500000 1093.2300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 242.9400 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 11.000000 659.1200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 27.500000 1647.8000 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 6 9.000000 728.8200 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 7 8.000000 647.8400 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 49.000000 3968.0200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 146 200.500000 16236.4900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 19.500000 1579.1100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 70 91.000000 7369.1800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 90.000000 5392.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 214 354.500000 21241.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 84.500000 6842.8100 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 113 177.000000 14333.4600 80.9800
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 64 64.000000 8185.7500 127.9023
OCTH-97165-OT EVAL LOW COMPLEXITY 16 16.000000 929.7600 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 13 13.000000 737.9800 56.7677
PSTH-97161GT-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 9 9.000000 522.9900 58.1100
SPCH-92522-EVAL OF SPCH SOUND PROD 4 4.000000 232.4400 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 364 1277.500000 94805.6000 74.2118
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 55.750000 2787.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 2.000000 100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 84 1984.500000 53581.5000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1041 10178.00000 549612.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 66.250000 3577.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 878 8864.000000 132960.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 221 1650.000000 19800.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 51 203.500000 16548.6200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 44 226.000000 14741.4200 65.2275
PHY-97110-PT SESSION BY LICENSED PT 59 250.000000 20330.0000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 32 202.500000 13175.6800 65.0651
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 318.500000 25900.4200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 55.000000 3581.6000 65.1200
Subtotal (Total Children Is Unduplicated) 1202 24060.00000 856896.2400 35.6150
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Total 30873.750000 1157650.3400 37.4963
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Number of Children (Unduplicated) With at Least One Service 1676
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Center 04
Flag Claims Units Chgs Paid
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R 131 212.750000 7914.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 1677 2657.250000 106843.8600 0.0000
P 13526 13695.000000 320319.4500 320339.4000
D 27 47.750000 1810.3800 0.0000
S 1 3.000000 111.6000 0.0000
H 8232 8148.000000 445790.2400 219.0000
T 0 0.000000 0.0000 0.0000
4616 5772.500000 249075.0000 90.0000
Other 612 337.500000 25785.5100 -120.0000
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Total 28822 30873.750000 1157650.3400 320528.4000