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
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 560 315.500000 11699.4000 37.0821
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 14 7.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 856 2533.500000 93883.5000 37.0568
Subtotal (Total Children Is Unduplicated) 967 2856.500000 105582.9000 36.9623
-----------------------------------------------------------------------------------------------------------------------
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 14 30.000000 2267.4400 75.5813
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 12.000000 794.8000 66.2333
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 13 26.000000 1557.9200 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 197 408.000000 31744.1600 77.8043
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 78 156.000000 12632.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 95.500000 7733.5900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 203 405.500000 24297.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 6.000000 283.7600 47.2933
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167TL-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 21 22.000000 1187.5600 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 6 7.000000 341.8700 48.8386
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 174.3300 58.1100
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 40.000000 2089.4300 52.2358
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 8.000000 464.8800 58.1100
Subtotal (Total Children Is Unduplicated) 305 1271.000000 89034.5400 70.0508
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 44 42.000000 2100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 46 49.750000 2487.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 18.250000 481.2500 26.3699
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 61 104.000000 5200.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 5 4.250000 212.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 31.500000 1606.3200 50.9943
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 90.500000 4525.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 41.250000 2062.5000 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 213 310.750000 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 527 2870.500000 154976.0000 53.9892
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 27 143.500000 7749.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 395 2322.000000 34830.0000 15.0000
INTR-T1013-INTERPRETER 3 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 371 2037.000000 24486.0000 12.0206
OCCT-97530-OT SESSION BY LICENSED OT 12 44.000000 3578.0800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 18 96.000000 6417.3200 66.8471
OCCT-97530HM-OT SESSION BY OT ASST 4 20.000000 1302.4000 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 29 94.250000 7705.0700 81.7514
OCCT-97530TLHM-OT SESSION BY OT ASST 4 23.000000 1497.7600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 36 169.500000 12822.5200 75.6491
PHY-97110HM-PT SESSION BY PT ASST 7 23.000000 1497.7600 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 29 101.500000 8253.9800 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 8 36.000000 2344.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 295.500000 22567.2900 76.3698
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 31 142.500000 11588.1000 81.3200
TRAV-TRAVS-Travel by mile 420 35750.00000 15904.2000 0.4449
Subtotal (Total Children Is Unduplicated) 740 44884.75000 337376.1200 7.5165
-----------------------------------------------------------------------------------------------------------------------
Total 49012.250000 531993.5600 10.8543
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1088
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 523 557.750000 20925.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 1017 1024.750000 48959.4700 162.0000
P 1050 1203.750000 73312.2200 70325.0800
D 41 43.750000 3595.0100 0.0000
S 12 12.500000 707.3200 0.0000
H 114 141.750000 11443.4100 0.0000
T 8787 42158.750000 192620.1900 179341.7700
4804 3864.500000 180209.2200 161.2200
Other 3 4.750000 220.8200 0.0000
---------------------------------------------------------
Total 16351 49012.250000 531993.5600 249990.0700