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
Payclass Filters:GR
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 1 1.000000 80.9800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 364.4100 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 4 5.000000 299.6000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 6.000000 163.8000 27.3000
Subtotal (Total Children Is Unduplicated) 14 30.500000 1904.4200 62.4400
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 10.000000 1225.4000 122.5400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 57.250000 2850.0000 49.7817
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 12 12.250000 612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 27 55.500000 2775.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 3.500000 175.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 4.000000 100.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 4.500000 225.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 15 43.000000 2150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 10.250000 512.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 3.750000 187.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 5.750000 287.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 4.750000 237.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 27.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 66 306.750000 16564.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 19.000000 1026.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 216 1479.000000 22185.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 66 323.000000 3876.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 49.500000 3699.7400 74.7422
PHY-97110-PT SESSION BY LICENSED PT 13 22.000000 1352.0100 61.4550
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 34.000000 2662.7800 78.3171
TRAV-TRAVS-Travel by mile 215 23782.00000 10575.6900 0.4447
Subtotal (Total Children Is Unduplicated) 284 26232.25000 73344.1200 2.7960
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Total 26262.750000 75248.5400 2.8652
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Number of Children (Unduplicated) With at Least One Service 286
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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 3764 25430.750000 71715.5700 71715.5700
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
169 832.000000 3532.9700 3532.9700
Other 0 0.000000 0.0000 0.0000
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Total 3933 26262.750000 75248.5400 75248.5400