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
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 191 213.500000 7942.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 115 376.750000 14015.1000 37.2000
Subtotal (Total Children Is Unduplicated) 253 590.250000 21957.3000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 7 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.500000 509.3200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.000000 119.8400 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 17 23.000000 1386.3100 60.2743
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 39.250000 1962.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 104 1051.000000 56754.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 5.250000 283.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 397 4248.000000 63720.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 90 714.000000 8568.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 9.000000 731.8800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 4 13.500000 1097.8200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 4.500000 365.9400 81.3200
Subtotal (Total Children Is Unduplicated) 488 6088.500000 133683.6400 21.9567
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Total 6701.750000 157027.2500 23.4308
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Number of Children (Unduplicated) With at Least One Service 556
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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 6108 6070.500000 133237.5800 133213.5800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 8.000000 117.0000 105.0000
T 0 0.000000 0.0000 0.0000
489 614.250000 23229.2800 60.0000
Other 13 9.000000 443.3900 -60.0000
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Total 6618 6701.750000 157027.2500 133318.5800