CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:OTHER
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 63 46.750000 1739.1000 37.2000
Subtotal (Total Children Is Unduplicated) 63 46.750000 1739.1000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 3 3.000000 174.3300 58.1100
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 4 8.000000 120.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 35 323.000000 4634.0000 14.3467
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.500000 121.9800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 1.000000 65.1200 65.1200
Subtotal (Total Children Is Unduplicated) 42 335.500000 5103.7400 15.2123
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Total 385.250000 7017.1700 18.2146
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Number of Children (Unduplicated) With at Least One Service 105
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Center 07
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 339 338.500000 5278.0700 5278.0700
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
0 0.000000 0.0000 0.0000
Other 117 46.750000 1739.1000 0.0000
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Total 456 385.250000 7017.1700 5278.0700