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
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 590 390.750000 14554.5000 37.2476
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 261 305.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 429 2251.750000 83765.1000 37.2000
Subtotal (Total Children Is Unduplicated) 772 2948.250000 98319.6000 33.3485
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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 10 15.000000 1193.7700 79.5847
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.500000 1549.2100 79.4467
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 19 22.500000 1386.0200 61.6009
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 14 26.000000 1515.9300 58.3050
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.000000 1661.9600 75.5436
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 24.000000 1841.8600 76.7442
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.500000 1249.4600 75.7248
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 8.500000 646.4700 76.0553
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 19.000000 1078.8100 56.7795
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 31.500000 1781.4000 56.5524
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 312.8000 44.6857
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 23.8900 23.8900
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 21.000000 665.9400 31.7114
Subtotal (Total Children Is Unduplicated) 101 272.000000 17640.7200 64.8556
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 24 37.000000 4088.7400 110.5065
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 210 271.250000 13550.0000 49.9539
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 73 71.000000 3550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 84 175.250000 8741.5000 49.8802
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 31 108.250000 5412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 12.750000 318.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 35 39.000000 1950.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 31 197.750000 9887.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 39 44.500000 2225.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 11 17.250000 862.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 49 53.000000 2650.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 33 37.000000 1850.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 2.750000 68.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 12.000000 308.0000 25.6667
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 7 22.500000 1149.0000 51.0667
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 173 1980.750000 104332.5000 52.6732
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 82.500000 4325.0000 52.4242
EPIC-99601-Early Steps Professional Development Fee 471 8320.000000 124740.0000 14.9928
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 252 2633.000000 31596.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 28 255.250000 18245.8100 71.4821
PHY-97110-PT SESSION BY LICENSED PT 42 199.250000 13816.2400 69.3412
PHY-97110GT-PT SESSION BY LICENSED PT 2 16.000000 1291.7600 80.7350
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 132.000000 9850.9100 74.6281
TRAV-TRAVS-Travel by mile 536 145289.0000 64619.6000 0.4448
Subtotal (Total Children Is Unduplicated) 646 160018.2500 429661.3100 2.6851
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Total 163238.500000 545621.6300 3.3425
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Number of Children (Unduplicated) With at Least One Service 856
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Center 05
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 23772 158848.250000 439908.9200 439908.9200
D 127 66.750000 2483.1000 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
6388 4321.000000 103136.6100 7393.1100
Other 5 2.500000 93.0000 0.0000
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Total 30292 163238.500000 545621.6300 447302.0300