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: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 525 297.500000 11029.8000 37.0750
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 6.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 772 2209.500000 81895.8000 37.0653
Subtotal (Total Children Is Unduplicated) 882 2513.500000 92925.6000 36.9706
-----------------------------------------------------------------------------------------------------------------------
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 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 10.000000 632.8400 63.2840
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1198.4000 59.9200
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 69 138.000000 11175.2400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 68.000000 5506.6400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 73.500000 5952.0300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 257.500000 15429.4000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 719.0400 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 5.000000 225.6500 45.1300
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 10 10.000000 539.8000 53.9800
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 167.5400 41.8850
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 39.000000 2031.3200 52.0851
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 199 672.000000 46021.8100 68.4848
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 27.500000 1375.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 27 23.250000 1162.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 7.750000 218.7500 28.2258
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 38 66.250000 3312.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.750000 87.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 30.000000 1531.3200 51.0440
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 37.250000 1862.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 196 303.750000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 256 1398.000000 75488.0000 53.9971
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 141.000000 7614.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 208 1163.000000 17445.0000 15.0000
INTR-T1013-INTERPRETER 3 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 221 1174.000000 14088.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 43.000000 3496.7600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 6 29.000000 1782.0800 61.4510
OCCT-97530HM-OT SESSION BY OT ASST 4 20.000000 1302.4000 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 19 59.250000 4858.8700 82.0062
OCCT-97530TLHM-OT SESSION BY OT ASST 4 23.000000 1497.7600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 25 142.000000 10586.2200 74.5508
PHY-97110TL-PT SESSION BY LICENSED PT 16 47.500000 3862.7000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 147.250000 11751.7300 79.8080
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 15 80.500000 6546.2600 81.3200
TRAV-TRAVS-Travel by mile 276 23739.00000 10560.8800 0.4449
Subtotal (Total Children Is Unduplicated) 445 28736.25000 182011.9800 6.3339
-----------------------------------------------------------------------------------------------------------------------
Total 31921.750000 320959.3900 10.0546
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 953
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 490 517.750000 19437.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 978 971.250000 46459.1900 162.0000
P 1012 1133.250000 68719.8600 66201.7200
D 37 35.750000 2947.1700 0.0000
S 12 12.500000 707.3200 0.0000
H 109 131.750000 10633.6100 0.0000
T 4764 26979.000000 94082.5200 80891.1000
3232 2135.750000 77751.0000 45.0000
Other 3 4.750000 220.8200 0.0000
---------------------------------------------------------
Total 10637 31921.750000 320959.3900 147299.8200