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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1784 1207.250000 44928.3000 37.2154
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 886 908.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2296 12971.75000 482521.2000 37.1978
Subtotal (Total Children Is Unduplicated) 2369 15087.50000 527449.5000 34.9594
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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 20 33.000000 2600.5800 78.8055
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 17 30.000000 2393.5200 79.7840
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 9.500000 760.3400 80.0358
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 16.500000 1291.3200 78.2618
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.000000 392.9400 78.5880
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 24 31.000000 1886.5000 60.8548
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 39.000000 2279.4200 58.4467
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 255.000000 20220.7700 79.2971
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 152 264.500000 21006.3400 79.4191
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 467.9400 77.9900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 40 66.500000 5319.3900 79.9908
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 95 153.500000 12125.4500 78.9932
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 33 54.500000 4302.7800 78.9501
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 179 312.000000 18385.5400 58.9280
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 204 356.000000 21013.2800 59.0261
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) 555 1830.500000 123100.1600 67.2495
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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 122 261.250000 13016.5000 49.8239
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 52 61.000000 3050.0000 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 65 71.750000 3587.5000 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 9 24.500000 1249.0000 50.9796
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 349 3727.750000 197752.5000 53.0488
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 114.750000 6042.5000 52.6580
EPIC-99601-Early Steps Professional Development Fee 846 11380.00000 170628.0000 14.9937
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 572 3842.000000 46104.0000 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 1190 211239.0000 93958.4400 0.4448
Subtotal (Total Children Is Unduplicated) 1345 234251.7500 759210.2500 3.2410
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Total 251169.750000 1409759.9100 5.6128
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Number of Children (Unduplicated) With at Least One Service 2381
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Center 05
Flag Claims Units Chgs Paid
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R 33 23.750000 855.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 10561 6191.750000 230333.1000 211545.5700
P 36785 231766.000000 865642.3800 865642.3800
D 167 92.750000 3450.3000 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
16638 12659.500000 293259.3300 16668.0300
Other 653 436.000000 16219.2000 13075.8000
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Total 64837 251169.750000 1409759.9100 1106931.7800