CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 202 406.000000 20300.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 461.9600 76.9933
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 773.9200 77.3920
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 271.4700 77.5629
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 675.0000 67.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 988.9300 56.5103
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 35.500000 2005.6100 56.4961
NUTR-97802-NUTRITIONAL EVAL, INITIAL 21 228.000000 11400.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 42 636.000000 31800.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
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 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 3.000000 174.3300 58.1100
SPCH-92523GT-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 25 424.000000 22976.3500 54.1895
Subtotal (Total Children Is Unduplicated) 328 1804.500000 93522.0400 51.8271
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 463 926.000000 46025.0000 49.7030
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 6 11.000000 550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 209 262.750000 6593.7500 25.0951
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 50 73.000000 3650.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 46 50.000000 2500.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 29 34.000000 1700.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 3.000000 25.0000 8.3333
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 54 61.250000 3062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 3.500000 87.5000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 5.000000 270.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 817 11094.00000 582241.0000 52.4825
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 39 108.000000 5600.0000 51.8519
EPIC-99601-Early Steps Professional Development Fee 1202 22875.00000 162399.0000 7.0994
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 430 5917.000000 70260.0000 11.8743
OCCT-97530-OT SESSION BY LICENSED OT 99 911.750000 70374.7900 77.1865
OCCT-97530GO-OT SESSION BY LICENSED OT 2 14.750000 1199.4700 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 306.5600 76.6400
OCCT-97530HM-OT SESSION BY OT ASST 17 135.000000 8180.0000 60.5926
PHY-97110-PT SESSION BY LICENSED PT 115 1302.500000 102049.3900 78.3489
PHY-97110HM-PT SESSION BY PT ASST 2 16.000000 1041.9200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 3.000000 195.3600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 169 1676.500000 129172.8400 77.0491
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 23.000000 1842.2800 80.0991
TRAV-TRAVS-Travel by mile 1693 431581.0000 191944.4000 0.4447
Subtotal (Total Children Is Unduplicated) 1771 477100.0000 1391570.7600 2.9167
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Total 478904.500000 1485092.8000 3.1010
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Number of Children (Unduplicated) With at Least One Service 1800
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Center 09
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 77395 457677.000000 1390359.5100 1390359.5100
D 491 3292.750000 12461.5800 0.0000
S 91 265.000000 1877.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1923 8675.500000 44698.5400 44698.5400
1645 8990.250000 35414.1200 0.0000
Other 2 4.000000 281.8000 0.0000
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Total 81547 478904.500000 1485092.8000 1435058.0500