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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 65 103.500000 3850.2000 37.2000
Subtotal (Total Children Is Unduplicated) 65 103.500000 3850.2000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 43 85.000000 4250.0000 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 3 4.500000 364.4100 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.500000 886.4200 77.0800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 17.500000 1372.3000 78.4171
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 715.8500 57.2680
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 17.500000 1011.0300 57.7731
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 850.2900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 20.000000 1508.9700 75.4485
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 65 109.500000 8326.1200 76.0376
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 31.000000 1729.3400 55.7852
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 48 75.000000 4237.6400 56.5019
NUTR-97802-NUTRITIONAL EVAL, INITIAL 8 43.000000 2150.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 29 150.000000 7500.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 27 286.000000 15517.6900 54.2577
Subtotal (Total Children Is Unduplicated) 219 889.500000 51565.5100 57.9713
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 112 192.500000 9525.0000 49.4805
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 51 56.000000 1375.0000 24.5536
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 17.000000 850.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 18.000000 900.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 511 4296.500000 225505.0000 52.4857
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 25.750000 1359.5000 52.7961
EPIC-99601-Early Steps Professional Development Fee 800 8048.000000 48696.0000 6.0507
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 135 694.000000 8172.0000 11.7752
OCCT-97530-OT SESSION BY LICENSED OT 88 831.750000 64612.9600 77.6832
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 9 60.000000 3907.2000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 129 1248.000000 96989.7600 77.7162
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 325.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 249 1847.250000 144597.2300 78.2770
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 15.000000 901.6000 60.1067
TRAV-TRAVS-Travel by mile 1097 115600.0000 51256.5600 0.4434
Subtotal (Total Children Is Unduplicated) 1194 132988.7500 660633.2100 4.9676
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Total 133981.750000 716048.9200 5.3444
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Number of Children (Unduplicated) With at Least One Service 1246
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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 28624 133208.250000 692837.7000 692837.7000
D 143 455.500000 4937.6700 0.0000
S 0 0.000000 0.0000 0.0000
H 199 310.000000 17703.9900 0.0000
T 0 0.000000 0.0000 0.0000
8 8.000000 569.5600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 28974 133981.750000 716048.9200 692837.7000