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
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 772 761.500000 28290.6000 37.1511
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 50 29.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 390 1847.250000 68262.0000 36.9533
Subtotal (Total Children Is Unduplicated) 866 2638.500000 96552.6000 36.5937
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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-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 11 24.000000 1420.4000 59.1833
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 923.9200 76.9933
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 623.9200 77.9900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 32.000000 1829.0400 57.1575
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 109.5200 54.7600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 8 8.000000 423.8800 52.9850
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 45 98.000000 6095.6400 62.2004
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 130 152.000000 7662.6400 50.4121
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 90 91.750000 4587.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 38 29.750000 781.2500 26.2605
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 87 263.000000 13150.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 9 10.250000 512.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 51 77.500000 3937.6400 50.8083
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 1.250000 62.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 22.250000 1187.5000 53.3708
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 105.000000 5250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 3.250000 162.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 275 1080.000000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 14.000000 700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 441.750000 23163.0000 52.4346
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 63.000000 3378.0000 53.6190
EPIC-99601-Early Steps Professional Development Fee 288 3941.000000 59112.0000 14.9992
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 338 3622.000000 43464.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 19.000000 1451.4800 76.3937
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 4 5.750000 467.5900 81.3200
PHY-97110-PT SESSION BY LICENSED PT 5 81.750000 6573.0300 80.4040
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 371 72227.00000 32131.7300 0.4449
Subtotal (Total Children Is Unduplicated) 581 82259.25000 208244.7000 2.5316
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Total 84995.750000 310892.9400 3.6577
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Number of Children (Unduplicated) With at Least One Service 919
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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 13 14.000000 682.0000 0.0000
S 6 7.250000 269.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 12748 80496.500000 170592.5700 164421.9200
7961 4478.000000 139348.6700 42.0000
Other 0 0.000000 0.0000 0.0000
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Total 20728 84995.750000 310892.9400 164463.9200