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
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 191 100.500000 3785.1000 37.6627
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 242 654.500000 24347.4000 37.2000
Subtotal (Total Children Is Unduplicated) 352 756.000000 28132.5000 37.2123
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 72 72.000000 3600.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 73 75.000000 3842.9400 51.2392
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 25.250000 1250.0000 49.5050
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 72 77.750000 3750.0000 48.2315
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 10.250000 243.7500 23.7805
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 4.000000 200.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 4 6.000000 300.0000 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
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 3.500000 175.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 145 1202.250000 64472.0000 53.6261
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 137.500000 7425.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 287 2010.000000 30000.0000 14.9254
INTR-T1013-INTERPRETER 14 111.000000 6275.0000 56.5315
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 180 1298.000000 15408.0000 11.8706
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 3.750000 244.2000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 39.500000 3212.1400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 569.2400 81.3200
Subtotal (Total Children Is Unduplicated) 443 4948.750000 134249.6100 27.1280
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Total 5779.750000 166225.0500 28.7599
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Number of Children (Unduplicated) With at Least One Service 549
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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 3845 3885.750000 104492.9500 104492.9500
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
2407 1889.750000 61574.0000 0.0000
Other 11 4.250000 158.1000 0.0000
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Total 6263 5779.750000 166225.0500 104492.9500