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
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 701 328.000000 12201.6000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 279 255.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1156 3260.500000 121290.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1186 3843.750000 133492.2000 34.7297
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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 4 6.500000 526.3700 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 31 56.500000 4575.3700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 41 73.500000 5952.0300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 18.000000 1457.6400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 30.500000 2469.8900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 16.000000 1295.6800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 70.500000 4224.3600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 54 93.000000 5572.5600 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) 150 427.000000 29451.0400 68.9720
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 15 17.000000 2129.9900 125.2935
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 474 2954.000000 44298.0000 14.9959
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 198 767.000000 9204.0000 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 576 52199.00000 23216.5500 0.4448
Subtotal (Total Children Is Unduplicated) 697 57831.50000 188211.8300 3.2545
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Total 62102.250000 351155.0700 5.6545
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Number of Children (Unduplicated) With at Least One Service 1209
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Center 05
Flag Claims Units Chgs Paid
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R 22 14.500000 539.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 2779 1596.500000 59389.8000 46826.1000
P 8556 54612.750000 205482.0300 205482.0300
D 35 12.250000 455.7000 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
4851 5799.000000 82786.4400 12180.8400
Other 113 67.250000 2501.7000 0.0000
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Total 16356 62102.250000 351155.0700 264488.9700