CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 8.000000 647.8400 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 6.000000 359.5200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 19.000000 1538.6200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 23 42.500000 3441.6500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 21.500000 1741.0700 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 10.000000 809.8000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 35.000000 2097.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 23 39.500000 2366.8400 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 91.3000 45.6500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 62.8100 31.4050
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 2 2.000000 20.7200 10.3600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 14.000000 364.5400 26.0386
Subtotal (Total Children Is Unduplicated) 92 239.500000 16141.6300 67.3972
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 16.000000 2031.0800 126.9425
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 92 93.750000 4649.0000 49.5893
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 20 19.000000 950.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 3.500000 87.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 56 102.000000 5100.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 7 8.250000 412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 4.000000 100.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 11.500000 575.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 27 67.000000 3350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 21.000000 1050.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 3.750000 187.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 14.000000 700.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 8 8.750000 437.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 10.000000 270.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 192 1000.500000 54027.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 29.750000 1606.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 454 2931.000000 43953.0000 14.9959
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 170 739.000000 8868.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 205.250000 14278.6400 69.5671
OCCT-97530GO-OT SESSION BY LICENSED OT 2 6.000000 487.9200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 37 120.500000 8634.5200 71.6558
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 163.000000 12240.7300 75.0965
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 56.3400 56.3400
TRAV-TRAVS-Travel by mile 502 50581.00000 22496.6400 0.4448
Subtotal (Total Children Is Unduplicated) 623 56161.50000 186712.0100 3.3246
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Total 56401.000000 202853.6400 3.5966
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Number of Children (Unduplicated) With at Least One Service 637
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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 8324 52789.750000 191254.9600 191254.9600
D 0 0.000000 0.0000 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
542 3611.250000 11598.6800 11598.6800
Other 0 0.000000 0.0000 0.0000
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Total 8866 56401.000000 202853.6400 202853.6400