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:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1260 2852.250000 106103.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1598 5905.250000 219731.1000 37.2094
Subtotal (Total Children Is Unduplicated) 1769 8757.500000 325834.8000 37.2064
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 143 224.000000 11200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.000000 242.9400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 8.500000 509.3200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 79.000000 6397.4200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 31 58.500000 4737.3300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 47.500000 3795.5900 79.9072
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 39 67.500000 5466.1500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 54.500000 4413.4100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 22 42.500000 3441.6500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 160.000000 9587.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 139 266.000000 15980.8400 60.0783
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SPCH-92522TLGT-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 139.4300 69.7150
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 481 1039.000000 67749.5600 65.2065
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 18 28.500000 1425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 10.000000 250.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 59 119.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 111.000000 5994.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 14.000000 756.0000 54.0000
INTR-T1013-INTERPRETER 90 407.000000 20200.0000 49.6314
OCCT-97530-OT SESSION BY LICENSED OT 5 5.000000 406.6000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 6 27.750000 2256.6300 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 90.750000 7356.5800 81.0642
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 243.9600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 9.000000 731.8800 81.3200
Subtotal (Total Children Is Unduplicated) 171 834.000000 40133.2900 48.1215
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Total 10630.500000 433717.6500 40.7994
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Number of Children (Unduplicated) With at Least One Service 1877
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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 5259 5512.250000 221060.6000 221060.6000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2179 2707.000000 116391.3700 114958.5300
T 950 1007.000000 41078.3100 41078.3100
1281 1400.250000 54905.5700 0.0000
Other 2 4.000000 281.8000 0.0000
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Total 9671 10630.500000 433717.6500 377097.4400