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
Payclass Filters:GR
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 5 1.250000 46.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 1.750000 65.1000 37.2000
Subtotal (Total Children Is Unduplicated) 7 3.000000 111.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 350.6800 58.4467
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 6 11.000000 716.6200 65.1473
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 47.000000 2350.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 91 121.500000 6075.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 44 37.000000 925.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 53 172.250000 8600.0000 49.9274
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 8 6.000000 300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 27.250000 1337.5000 49.0826
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 271.250000 13562.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 5 4.500000 225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 24.500000 1225.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 225.000000 11966.0000 53.1822
EPIC-99601-Early Steps Professional Development Fee 287 3479.000000 52185.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 241 2045.000000 24540.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 153.2800 76.6400
OCCT-97530GO-OT SESSION BY LICENSED OT 1 5.000000 359.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 4.000000 245.3600 61.3400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 42.000000 3248.7600 77.3514
TRAV-TRAVS-Travel by mile 234 33314.00000 14820.5700 0.4449
Subtotal (Total Children Is Unduplicated) 470 39833.75000 142418.9100 3.5753
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Total 39847.750000 143247.1300 3.5949
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Number of Children (Unduplicated) With at Least One Service 473
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Center 52
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 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 9127 39844.750000 143135.5300 143135.5300
8 3.000000 111.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9135 39847.750000 143247.1300 143135.5300