CMS/EIP Fiscal Report Center: 07
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 611 775.250000 28839.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 18.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 239 439.250000 16349.4000 37.2212
Subtotal (Total Children Is Unduplicated) 656 1232.750000 45188.7000 36.6568
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
EXIT-EXIT-COS Exit 119 138.250000 7450.0000 53.8879
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 111.9600 55.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 958.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 354.1700 50.5957
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 162.8000 40.7000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 14.000000 302.6000 21.6143
Subtotal (Total Children Is Unduplicated) 156 222.250000 11995.3200 53.9722
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 547.0600 273.5300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 46.000000 2300.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 128 152.000000 7600.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 8.000000 200.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 135 234.750000 11737.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 187 349.750000 17487.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 59 80.750000 4037.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 80 128.250000 6412.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 38.000000 1900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 41 57.000000 2850.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 86 120.500000 6025.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 97 149.750000 7487.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 9 17.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 275 2064.000000 111396.6000 53.9712
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 107.750000 5818.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 432 3373.000000 50580.0000 14.9956
INTR-T1013-INTERPRETER 1 2.000000 161.7000 80.8500
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 547 5277.000000 63144.0000 11.9659
OCCT-97530-OT SESSION BY LICENSED OT 28 153.500000 10529.4600 68.5958
OCCT-97530GT-OT SESSION BY LICENSED OT 1 7.000000 225.6800 32.2400
OCCT-97530HM-OT SESSION BY OT ASST 1 9.000000 586.0800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 25 171.500000 12329.0800 71.8897
PHY-97110HM-PT SESSION BY PT ASST 1 7.000000 455.8400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 197.250000 11872.3700 60.1895
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.750000 248.9900 52.4189
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 43.000000 2289.9500 53.2547
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 3 5.000000 230.6100 46.1220
TRAV-TRAVS-Travel by mile 31 2579.000000 1147.2000 0.4448
Subtotal (Total Children Is Unduplicated) 822 15388.25000 339688.1200 22.0745
-----------------------------------------------------------------------------------------------------------------------
Total 16843.250000 396872.1400 23.5627
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 974
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 13201 15575.250000 350226.4900 350226.4900
D 29 14.250000 530.1000 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
2445 1261.750000 46488.8300 0.0000
Other 8 -8.000000 -373.2800 -373.2800
---------------------------------------------------------
Total 15683 16843.250000 396872.1400 349853.2100