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
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 2008 11399.25000 424457.2000 37.2355
TCM-T1017TL-TARGETED CASE MANAGEMENT 1182 10382.50000 386282.8600 37.2052
Subtotal (Total Children Is Unduplicated) 2145 21781.75000 810740.0600 37.2211
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 857 1494.000000 74700.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 274.4600 78.4171
IPDEF-T1024GPTS-F/U PSYCH 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 341.8400 56.9733
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1541.8600 77.0930
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 586.4200 78.1893
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 19.500000 1483.4300 76.0733
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 30.500000 2356.2700 77.2548
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 496.4700 76.3800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 17.500000 1258.4300 71.9103
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 39.000000 2213.1200 56.7467
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 30 57.500000 3257.5500 56.6530
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 2 4.000000 225.7400 56.4350
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) 984 3012.000000 156088.7500 51.8223
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 481 978.250000 48637.5000 49.7189
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 53 85.000000 4250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 231 294.500000 7387.5000 25.0849
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 56 79.000000 3950.0000 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
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 32 38.000000 1900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 3.000000 25.0000 8.3333
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 65 74.250000 3712.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 6 7.000000 350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.500000 112.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 86 535.000000 211.9600 0.3962
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 5.000000 270.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 837 11372.25000 596888.5000 52.4864
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 119.000000 6190.0000 52.0168
EPIC-99601-Early Steps Professional Development Fee 1204 22906.00000 162864.0000 7.1101
INTR-T1013-INTERPRETER 126 666.500000 33325.0000 50.0000
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 175 1690.500000 130255.1600 77.0513
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 25.000000 1986.2000 79.4480
TRAV-TRAVS-Travel by mile 1703 432497.0000 192351.9100 0.4447
Subtotal (Total Children Is Unduplicated) 1834 479744.7500 1451175.2200 3.0249
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Total 504538.500000 2418004.0300 4.7925
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Number of Children (Unduplicated) With at Least One Service 2297
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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 102184 482588.250000 2298094.5300 2296313.2800
D 499 3361.750000 12550.5000 0.0000
S 91 265.000000 1877.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 2301 9044.750000 58525.8400 58525.8400
1897 9269.250000 46390.6800 0.0000
Other 5 9.500000 565.2300 0.0000
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Total 106977 504538.500000 2418004.0300 2354839.1200