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
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 213 133.750000 4956.9000 37.0609
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7 3.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 131 256.250000 9504.6000 37.0911
Subtotal (Total Children Is Unduplicated) 276 393.500000 14461.5000 36.7510
-----------------------------------------------------------------------------------------------------------------------
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 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 8 16.000000 980.1200 61.2575
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 19.500000 975.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 18 15.750000 787.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 6.000000 175.0000 29.1667
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 47.750000 2387.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.750000 87.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 14.500000 756.3200 52.1600
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 31.750000 1587.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 88 188.000000 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 16 67.750000 3654.5000 53.9410
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 13.000000 702.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 122 734.000000 11010.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 106 630.000000 7560.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.750000 223.6300 81.3200
PHY-97110-PT SESSION BY LICENSED PT 4 36.000000 2927.5200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 143 13351.00000 5939.5900 0.4449
Subtotal (Total Children Is Unduplicated) 216 15173.75000 39667.7300 2.6142
-----------------------------------------------------------------------------------------------------------------------
Total 15583.250000 55109.3500 3.5364
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 341
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2350 14840.500000 31071.2600 30088.2600
1371 742.750000 24038.0900 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3721 15583.250000 55109.3500 30118.2600