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: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 1255 1112.750000 41310.8500 37.1250
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 66 42.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1509 8126.250000 300417.9000 36.9688
Subtotal (Total Children Is Unduplicated) 1636 9281.500000 341728.7500 36.8183
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Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 34.000000 2540.6800 74.7259
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 26.000000 1703.7200 65.5277
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 16.000000 1283.7200 80.2325
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 38 80.000000 4740.5600 59.2570
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 228 461.000000 35777.0200 77.6074
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.500000 2494.0600 79.1765
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 107 214.500000 16599.9800 77.3892
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 230.9800 57.7450
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 127 260.000000 19955.5700 76.7522
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 11.000000 672.1600 61.1055
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 467 929.500000 54665.7800 58.8120
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1744.5600 58.1520
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 18.000000 1361.9600 75.6644
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 14 15.000000 800.0500 53.3367
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 5 5.000000 283.8500 56.7700
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 109.5200 54.7600
PSTH-97161TL-PT EVAL LOW COMPLEXITY 2 2.000000 109.5200 54.7600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 290.5500 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
SCREEN-T1023-SCREENING 34 34.000000 1791.5400 52.6924
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 15.000000 779.9500 51.9967
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 167.6300 55.8767
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 3.000000 109.4300 36.4767
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 16 159.000000 8008.8100 50.3699
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 8.000000 478.7300 59.8413
Subtotal (Total Children Is Unduplicated) 668 2382.500000 157621.7900 66.1581
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 148 165.750000 8350.1400 50.3779
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 106 105.250000 5262.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 42 31.500000 825.0000 26.1905
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 112 298.750000 14937.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 10 11.250000 562.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.250000 31.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 69 105.500000 5337.6400 50.5937
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 3 1.500000 75.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 31.000000 1625.0000 52.4194
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 44 127.250000 6362.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 3.250000 162.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 460 1328.750000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 16.000000 800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 517 5577.750000 294627.5000 52.8219
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 50 603.750000 31974.5000 52.9598
EPIC-99601-Early Steps Professional Development Fee 390 4632.000000 69477.0000 14.9994
INTR-T1013-INTERPRETER 3 26.000000 1300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 473 4584.000000 55008.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 242.000000 18317.6200 75.6926
OCCT-97530GO-OT SESSION BY LICENSED OT 12 62.000000 3813.2600 61.5042
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 4 28.000000 1823.3600 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 5.000000 387.8800 77.5760
OCCT-97530TLGO-OT SESSION BY LICENSED OT 40 279.750000 22523.1700 80.5118
OCCT-97530TLHM-OT SESSION BY OT ASST 5 29.000000 1888.4800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 45 604.500000 42131.8100 69.6970
PHY-97110TL-PT SESSION BY LICENSED PT 33 285.500000 22246.0800 77.9197
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 549.500000 38346.7300 69.7848
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 40.6600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 24 266.500000 21374.7400 80.2054
TRAV-TRAVS-Travel by mile 537 88737.00000 39476.2500 0.4449
Subtotal (Total Children Is Unduplicated) 884 108742.5000 709204.2800 6.5219
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Total 120406.500000 1208554.8200 10.0373
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Number of Children (Unduplicated) With at Least One Service 1648
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Center 52
Flag Claims Units Chgs Paid
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R 495 520.000000 19512.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 1555 1574.250000 71771.2400 162.0000
P 7811 8010.750000 423003.0800 414760.0700
D 329 363.250000 27225.0300 15.0000
S 151 174.750000 7660.8900 1037.5900
H 184 229.000000 18061.4300 0.0000
T 18134 101225.750000 351732.4600 306169.5200
12456 8241.000000 286051.5200 297.7200
Other 56 67.750000 3536.8700 3073.0500
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Total 41171 120406.500000 1208554.8200 725514.9500