CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2025 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 1.000000 37.2000 37.2000
Subtotal (Total Children Is Unduplicated) 2 1.000000 37.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 18.000000 1295.6800 71.9822
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 79 171.500000 12754.3500 74.3694
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 48.000000 3887.0400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 46.000000 2756.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
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
SCREEN-T1023-SCREENING 12 12.000000 647.7600 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 121 320.500000 22938.3600 71.5705
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 14 14.500000 725.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 23 26.500000 1325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 10.500000 262.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 32 37.750000 1887.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 2.500000 125.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 1.500000 75.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 80.500000 4025.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 275 1472.500000 79488.0000 53.9817
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 2.500000 135.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 219 1159.000000 17385.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 162 863.000000 10398.0000 12.0487
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 12 67.000000 4635.2400 69.1827
OCCT-97530TLGO-OT SESSION BY LICENSED OT 10 35.000000 2846.2000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 11 27.500000 2236.3000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 7 23.000000 1497.7600 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 13 54.000000 4391.2800 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 8 36.000000 2344.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 148.250000 10815.5600 72.9549
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 17 62.000000 5041.8400 81.3200
TRAV-TRAVS-Travel by mile 175 12000.00000 5338.4300 0.4449
Subtotal (Total Children Is Unduplicated) 376 16130.50000 155359.2500 9.6314
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Total 16452.000000 178334.8100 10.8397
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Number of Children (Unduplicated) With at Least One Service 458
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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 3982 15088.750000 92865.2600 92823.2600
1278 1362.750000 85450.9500 116.2200
Other 0 0.000000 0.0000 0.0000
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Total 5261 16452.000000 178334.8100 92939.4800