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
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 535 1241.500000 46183.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 375 1345.000000 50034.0000 37.2000
Subtotal (Total Children Is Unduplicated) 669 2586.500000 96217.8000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 152 252.000000 12600.0000 50.0000
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 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
NUTR-97802-NUTRITIONAL EVAL, INITIAL 12 67.000000 3350.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 13 112.000000 5600.0000 50.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 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 14 145.000000 8425.9500 58.1100
Subtotal (Total Children Is Unduplicated) 192 606.000000 32048.8100 52.8858
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 134 252.250000 12587.5000 49.9009
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 30.500000 1525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 47 64.500000 1612.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 13.000000 700.0000 53.8462
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 34 70.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 255 1568.000000 84672.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 4.000000 216.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 522 4277.000000 29649.0000 6.9322
INTR-T1013-INTERPRETER 23 100.250000 5012.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 116 775.000000 9204.0000 11.8761
OCCT-97530-OT SESSION BY LICENSED OT 43 207.000000 16833.2400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 8.750000 711.5500 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 12 71.000000 4102.5600 57.7825
PHY-97110-PT SESSION BY LICENSED PT 61 355.500000 28612.2000 80.4844
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 88 471.000000 37651.1600 79.9388
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 15.000000 1219.8000 81.3200
TRAV-TRAVS-Travel by mile 689 74974.00000 33334.1600 0.4446
Subtotal (Total Children Is Unduplicated) 754 83276.25000 268563.5300 3.2250
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Total 86468.750000 396830.1400 4.5893
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Number of Children (Unduplicated) With at Least One Service 895
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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 13228 68145.750000 291466.8300 291466.8300
D 79 307.000000 2520.5500 0.0000
S 91 265.000000 1877.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 2171 8477.750000 54293.0300 54293.0300
1897 9269.250000 46390.6800 0.0000
Other 2 4.000000 281.8000 0.0000
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Total 17468 86468.750000 396830.1400 345759.8600