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: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 98 156.500000 5821.8000 37.2000
Subtotal (Total Children Is Unduplicated) 98 156.500000 5821.8000 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 7 12.000000 971.7600 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.500000 1198.3800 77.3148
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 12 21.000000 1643.7700 78.2748
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
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 13 23.500000 1366.1300 58.1332
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 22.000000 1274.0400 57.9109
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 12.000000 971.7600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 36.000000 2762.7900 76.7442
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 102 172.000000 13082.3900 76.0604
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 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 26 46.000000 2606.0400 56.6530
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 66 102.000000 5758.2400 56.4533
NUTR-97802-NUTRITIONAL EVAL, INITIAL 8 44.000000 2200.0000 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) 282 1057.000000 63346.2800 59.9303
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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
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.250000 0.0000 0.0000
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 136 695.000000 8184.0000 11.7755
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 250 1848.250000 144678.5500 78.2787
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) 1196 132992.0000 660726.5300 4.9682
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Total 134205.500000 729894.6100 5.4386
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Number of Children (Unduplicated) With at Least One Service 1312
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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 28662 133276.500000 697769.5300 697769.5300
D 144 456.500000 4949.6700 0.0000
S 0 0.000000 0.0000 0.0000
H 296 461.500000 26494.2500 0.0000
T 0 0.000000 0.0000 0.0000
9 11.000000 681.1600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 29111 134205.500000 729894.6100 697769.5300