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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 8.250000 412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 15 19.500000 975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.000000 175.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 15.500000 775.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 2.500000 125.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 52.500000 2625.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 42.000000 2268.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 119 625.000000 9375.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 60 304.000000 3648.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 95 7308.000000 3251.2700 0.4449
Subtotal (Total Children Is Unduplicated) 176 8394.250000 24253.9700 2.8894
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Total 8394.250000 24253.9700 2.8894
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Number of Children (Unduplicated) With at Least One Service 176
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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 1575 8394.250000 24253.9700 24253.9700
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1575 8394.250000 24253.9700 24253.9700