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
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 1370 1171.500000 43487.0500 37.1208
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 71 45.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1735 9189.750000 339849.9000 36.9814
Subtotal (Total Children Is Unduplicated) 1863 10406.25000 383336.9500 36.8372
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Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 66 148.000000 11039.7300 74.5928
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 23 56.000000 3935.2800 70.2729
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 20.000000 1595.6800 79.7840
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 54 112.000000 6631.4800 59.2096
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 682 1419.000000 107845.1000 76.0008
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 63.000000 4964.2000 78.7968
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 270 545.500000 42248.2200 77.4486
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1241.8600 73.0506
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 162 330.000000 25393.3900 76.9497
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 739 1471.000000 86562.1700 58.8458
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2223.9200 58.5242
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 28.000000 2092.4600 74.7307
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 19 21.000000 1083.9000 51.6143
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 5 5.000000 283.8500 56.7700
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 109.5200 54.7600
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
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 5 5.000000 277.1500 55.4300
SCREEN-T1023-SCREENING 79 81.000000 4288.8000 52.9481
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 35.000000 1662.8100 47.5089
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 547.6000 54.7600
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 7 8.000000 399.9800 49.9975
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 23 222.000000 10710.9900 48.2477
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 11 41.000000 2255.6600 55.0161
Subtotal (Total Children Is Unduplicated) 1017 4721.500000 320030.8800 67.7816
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 185 222.750000 11200.1400 50.2812
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 202 241.000000 12050.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 95 75.000000 1912.5000 25.5000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 163 507.000000 25337.5000 49.9753
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 19 17.750000 887.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 87 133.250000 6700.1400 50.2825
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 5 2.500000 125.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 71 363.500000 18250.0000 50.2063
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 66 154.750000 7737.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 3.250000 162.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.750000 43.7500 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 523 1360.250000 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 908 10558.75000 559626.3500 53.0012
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 53 607.250000 32159.5000 52.9592
EPIC-99601-Early Steps Professional Development Fee 708 9281.000000 139212.0000 14.9997
INTR-T1013-INTERPRETER 3 26.000000 1300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 758 7607.000000 91326.0000 12.0055
OCCT-97530-OT SESSION BY LICENSED OT 67 370.500000 26639.5200 71.9015
OCCT-97530GO-OT SESSION BY LICENSED OT 28 204.000000 13052.5800 63.9832
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 15 65.000000 4761.6400 73.2560
OCCT-97530TLGO-OT SESSION BY LICENSED OT 50 317.750000 25613.3300 80.6084
OCCT-97530TLHM-OT SESSION BY OT ASST 5 29.000000 1888.4800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 71 765.000000 54626.3900 71.4070
PHY-97110HM-PT SESSION BY PT ASST 14 150.000000 9300.3600 62.0024
PHY-97110TL-PT SESSION BY LICENSED PT 53 481.500000 37801.0400 78.5068
CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 2
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110TLHM-PT SESSION BY PT ASST 14 169.000000 10705.0400 63.3434
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 128 1339.000000 91784.7100 68.5472
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 1.500000 112.6200 75.0800
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 72 685.500000 53688.1400 78.3197
TRAV-TRAVS-Travel by mile 788 131148.0000 58343.6400 0.4449
Subtotal (Total Children Is Unduplicated) 1334 166943.2500 1299399.4400 7.7835
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Total 182071.000000 2002767.2700 10.9999
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Number of Children (Unduplicated) With at Least One Service 1886
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Center 52
Flag Claims Units Chgs Paid
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R 528 560.000000 21000.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 1646 1701.250000 77395.8800 162.0000
P 8076 8421.250000 445026.6200 435483.2500
D 357 418.000000 31456.2300 15.0000
S 178 205.250000 8840.9300 1148.5900
H 205 269.250000 21005.1300 0.0000
T 33699 156065.000000 758994.5900 713054.5500
18012 14361.250000 635360.7200 635.8600
Other 57 69.750000 3686.8700 3223.0500
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Total 62758 182071.000000 2002767.2700 1153722.3000