CMS/EIP Fiscal Report Center: 06
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: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 1017 768.500000 28634.7000 37.2605
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 9.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 777 4673.000000 173854.2000 37.2040
Subtotal (Total Children Is Unduplicated) 1306 5451.000000 202488.9000 37.1471
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 366 343.250000 16958.7500 49.4064
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 159.9200 53.3067
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 683.9700 75.9967
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 152.9900 76.4950
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.500000 502.4500 77.3000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.000000 113.2100 56.6050
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 381 386.250000 19968.8500 51.6993
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 213 252.250000 12302.0000 48.7691
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 275 338.750000 16562.5000 48.8930
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 129 128.500000 3106.2500 24.1732
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 24.000000 1200.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 9 18.250000 912.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 7.250000 181.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 7.500000 375.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 9 20.500000 1025.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 6.750000 187.5000 27.7778
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 15.000000 725.0000 48.3333
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 6.500000 306.2500 47.1154
CONPP-CONPP-CONSULT, PT, PHONE 1 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 456 8527.000000 441558.5000 51.7836
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 116 1066.750000 55326.0000 51.8641
EPIC-99601-Early Steps Professional Development Fee 678 11857.00000 176496.0000 14.8854
INTR-T1013-INTERPRETER 49 872.500000 55050.0000 63.0946
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 601 9877.000000 116370.0000 11.7819
OCCT-97530-OT SESSION BY LICENSED OT 4 47.500000 2263.2200 47.6467
OCCT-97530GT-OT SESSION BY LICENSED OT 1 0.500000 35.9800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 7.000000 172.8000 24.6857
OCCT-97530HMGT-OT SESSION BY OT ASST 2 9.000000 518.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 4 17.750000 1443.4300 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 406.6000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 18.750000 1044.9700 55.7317
PHY-97110HMGT-PT SESSION BY PT ASST 2 15.000000 935.7600 62.3840
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 227.250000 17862.2100 78.6016
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 53.500000 4169.5600 77.9357
Subtotal (Total Children Is Unduplicated) 1178 33435.75000 910886.6800 27.2429
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Total 39273.000000 1133344.4300 28.8581
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Number of Children (Unduplicated) With at Least One Service 1606
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Center 06
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 32098 32534.250000 888731.1200 888731.1200
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
10495 6668.500000 241912.4500 0.0000
Other 124 70.250000 2700.8600 0.0000
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Total 42717 39273.000000 1133344.4300 888731.1200