CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
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 6 1.500000 55.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 3.500000 130.2000 37.2000
Subtotal (Total Children Is Unduplicated) 12 5.000000 186.0000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 38 82.000000 6129.4500 74.7494
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 20.000000 1457.6400 72.8820
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 297 629.500000 47205.9900 74.9897
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1235.8800 77.2425
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 111 227.000000 17369.8400 76.5191
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 104 208.000000 12251.2000 58.9000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 280.5000 70.1250
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 6.000000 283.8500 47.3083
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 3 3.000000 167.6300 55.8767
SCREEN-T1023-SCREENING 46 47.000000 2497.2600 53.1332
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 20.000000 882.8600 44.1430
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 379.9700 54.2814
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 290.5500 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 63.000000 2702.1800 42.8917
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 33.000000 1776.9300 53.8464
Subtotal (Total Children Is Unduplicated) 475 1392.500000 96272.7300 69.1366
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 46 57.000000 2850.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 107 135.750000 6787.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 53 43.500000 1087.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 76 208.250000 10400.0000 49.9400
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 9 6.500000 325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 27.750000 1362.5000 49.0991
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 44 332.500000 16625.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 5 4.500000 225.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 27.500000 1375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 460 4980.000000 264948.8500 53.2026
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 3.500000 185.0000 52.8571
EPIC-99601-Early Steps Professional Development Fee 406 4648.000000 69720.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 365 3023.000000 36318.0000 12.0139
OCCT-97530-OT SESSION BY LICENSED OT 21 128.500000 8321.9000 64.7619
OCCT-97530GO-OT SESSION BY LICENSED OT 17 142.000000 9239.3200 65.0656
OCCT-97530TL-OT SESSION BY LICENSED OT 14 60.000000 4373.7600 72.8960
OCCT-97530TLGO-OT SESSION BY LICENSED OT 10 38.000000 3090.1600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 26 160.500000 12494.5800 77.8479
PHY-97110HM-PT SESSION BY PT ASST 14 150.000000 9300.3600 62.0024
PHY-97110TL-PT SESSION BY LICENSED PT 21 196.000000 15554.9600 79.3620
PHY-97110TLHM-PT SESSION BY PT ASST 14 169.000000 10705.0400 63.3434
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 84 789.500000 53437.9800 67.6859
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 52 419.000000 32313.4000 77.1203
TRAV-TRAVS-Travel by mile 329 42265.00000 18802.4300 0.4449
Subtotal (Total Children Is Unduplicated) 703 58021.25000 590065.2000 10.1698
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Total 59418.750000 686523.9300 11.5540
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Number of Children (Unduplicated) With at Least One Service 923
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Center 52
Flag Claims Units Chgs Paid
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R 1 0.500000 18.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 15415 54430.750000 387679.6700 387637.6700
4601 4987.500000 298825.6600 338.1400
Other 0 0.000000 0.0000 0.0000
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Total 20017 59418.750000 686523.9300 387975.8100