CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2025 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 2 3.500000 130.2000 37.2000
Subtotal (Total Children Is Unduplicated) 2 3.500000 130.2000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 16 32.000000 1600.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 22 46.000000 2545.6600 55.3404
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 23.000000 1150.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 5.000000 250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 129 500.500000 27027.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 280 1249.000000 8022.0000 6.4227
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 15 73.000000 876.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 33 157.000000 12767.2400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 6 24.000000 1562.8800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 70 368.000000 29925.7600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 325.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 407.000000 33097.2400 81.3200
TRAV-TRAVS-Travel by mile 332 15916.00000 7078.1000 0.4447
Subtotal (Total Children Is Unduplicated) 383 18732.50000 122281.8200 6.5278
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Total 18782.000000 124957.6800 6.6531
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Number of Children (Unduplicated) With at Least One Service 394
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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 4287 18658.000000 122350.9400 122350.9400
D 31 105.500000 1371.7100 0.0000
S 0 0.000000 0.0000 0.0000
H 6 10.500000 665.4700 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 4332 18782.000000 124957.6800 122350.9400