CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 727 403.250000 15112.5000 37.4768
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1810 5964.000000 221935.2000 37.2125
Subtotal (Total Children Is Unduplicated) 1816 6368.750000 237047.7000 37.2204
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 89 89.000000 4450.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 242.9400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 2.500000 202.4500 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 149.8000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 88 102.500000 8300.4500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 83 110.500000 8948.2900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 77 91.000000 7369.1800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 70 101.000000 8178.9800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 47.500000 3806.0600 80.1276
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 51.500000 4170.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 78 96.000000 5752.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 110 153.500000 9197.7200 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 402 857.500000 61312.6500 71.5016
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 2.000000 138.7000 69.3500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 57.250000 2850.0000 49.7817
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 358 376.000000 18662.5000 49.6343
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 24 23.000000 556.2500 24.1848
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 6.500000 325.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 7 6.250000 312.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 2.000000 100.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 5 8.000000 400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 4.000000 175.0000 43.7500
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 3.500000 175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 886 6738.250000 362829.0000 53.8462
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 209 1111.750000 59494.5000 53.5143
EPIC-99601-Early Steps Professional Development Fee 652 4311.000000 64497.0000 14.9610
INTR-T1013-INTERPRETER 64 540.000000 34885.0000 64.6019
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 428 2865.000000 33936.0000 11.8450
OCCT-97530-OT SESSION BY LICENSED OT 6 35.250000 2866.5300 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 0.500000 40.6600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 5 20.000000 1618.3000 80.9150
OCCT-97530HM-OT SESSION BY OT ASST 3 5.000000 325.6000 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.500000 65.1200 43.4133
PHY-97110-PT SESSION BY LICENSED PT 14 128.000000 9430.6400 73.6769
PHY-97110GT-PT SESSION BY LICENSED PT 4 9.500000 772.5400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 9 68.000000 4165.0500 61.2507
PHY-97110HMGT-PT SESSION BY PT ASST 6 24.000000 1410.7100 58.7796
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 203.500000 16548.6200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 88.000000 7156.1600 81.3200
Subtotal (Total Children Is Unduplicated) 1223 16642.25000 623861.3800 37.4866
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Total 23868.500000 922221.7300 38.6376
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Number of Children (Unduplicated) With at Least One Service 1863
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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 8495 8604.500000 252249.9000 252249.9000
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
18668 15203.250000 667492.6000 0.0000
Other 114 60.750000 2479.2300 0.0000
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Total 27277 23868.500000 922221.7300 252249.9000