CMS/EIP Fiscal Report Center: 05
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 1383 975.250000 36297.9000 37.2191
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 598 640.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1846 10497.25000 390469.8000 37.1973
Subtotal (Total Children Is Unduplicated) 1919 12112.75000 426767.7000 35.2329
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 20.000000 1592.6900 79.6345
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 26.000000 2069.6000 79.6000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 8.000000 647.8400 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 13.500000 1066.3200 78.9867
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 21 25.500000 1565.7800 61.4031
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 30.000000 1755.6100 58.5203
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 72 136.500000 10799.6200 79.1181
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 95 170.000000 13521.4200 79.5378
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 31.000000 2462.5400 79.4368
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 106.000000 8395.5100 79.2029
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 26 44.500000 3516.9000 79.0315
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 93 169.500000 9984.0600 58.9030
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 115 207.500000 12272.0700 59.1425
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 131.4300 43.8100
OCTH-97165-OT EVAL LOW COMPLEXITY 8 8.000000 360.0100 45.0013
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 11.000000 585.6100 53.2373
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 2.000000 66.3800 33.1900
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 371.3300 46.4163
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 19 19.000000 1008.5600 53.0821
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 335.2600 55.8767
SPCH-92521-EVAL OF SPEECH FLUENCY 10 10.000000 567.7000 56.7700
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 28 31.000000 1498.3100 48.3326
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 167.6300 55.8767
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 161.1500 32.2300
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 23.8900 23.8900
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 12 86.000000 3059.1600 35.5716
Subtotal (Total Children Is Unduplicated) 354 1188.000000 78425.4800 66.0147
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 34 48.000000 5217.4600 108.6971
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 270 348.750000 17399.0000 49.8896
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 91 92.250000 4612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 11.250000 281.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 121 260.250000 12966.5000 49.8232
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 45 133.250000 6662.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 15.250000 381.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 51 60.000000 3000.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 49 245.750000 12287.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 54 72.250000 3612.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 12 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 64 70.750000 3537.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 49 54.500000 2725.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.750000 68.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 29.000000 767.0000 26.4483
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 23.500000 1199.0000 51.0213
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 346 3705.750000 196624.5000 53.0593
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 114.750000 6042.5000 52.6580
EPIC-99601-Early Steps Professional Development Fee 754 11240.00000 168528.0000 14.9936
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 447 3705.000000 44460.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 58 814.500000 59203.7700 72.6873
OCCT-97530GO-OT SESSION BY LICENSED OT 2 6.000000 487.9200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 16.000000 1301.1200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 79 774.750000 50810.5800 65.5832
PHY-97110GT-PT SESSION BY LICENSED PT 3 21.000000 1670.2800 79.5371
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 75 825.500000 55377.0900 67.0831
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 56.3400 56.3400
TRAV-TRAVS-Travel by mile 909 204294.0000 90868.4400 0.4448
Subtotal (Total Children Is Unduplicated) 1058 227003.7500 751048.2500 3.3085
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Total 240304.500000 1256241.4300 5.2277
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Number of Children (Unduplicated) With at Least One Service 1931
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Center 05
Flag Claims Units Chgs Paid
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R 32 23.250000 837.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9348 5190.250000 193077.3000 176603.5800
P 35748 223910.500000 813401.4500 813401.4500
D 161 87.750000 3264.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13821 10735.500000 232371.6800 16072.2800
Other 561 357.250000 13289.7000 10146.3000
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Total 59671 240304.500000 1256241.4300 1016223.6100