CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 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 1942 1819.500000 67666.8000 37.1898
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 320 286.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3266 20265.75000 753889.5600 37.2002
Subtotal (Total Children Is Unduplicated) 3327 22371.50000 821556.3600 36.7233
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 6 7.000000 817.8100 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 4 4.000000 453.8500 113.4625
AACIS-92597TLGT-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 40 43.000000 2085.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.500000 1045.3900 77.4363
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 21.000000 1688.6200 80.4105
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 47.000000 3659.3000 77.8574
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 28 54.500000 4332.6800 79.4987
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 473.9200 78.9867
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 41.500000 2424.8000 58.4289
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.500000 769.3100 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 141.000000 11226.8200 79.6228
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 81 157.500000 12473.2900 79.1955
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 174 323.500000 25889.0600 80.0280
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 267 500.000000 40020.7000 80.0414
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 31.500000 2639.7000 83.8000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 52 99.000000 7813.7000 78.9263
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 72.500000 4242.2900 58.5143
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 196 384.000000 22611.7400 58.8847
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 157 309.000000 24329.1400 78.7351
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 141.000000 11095.2600 78.6898
SCREEN-T1023-SCREENING 8 9.000000 485.8200 53.9800
Subtotal (Total Children Is Unduplicated) 1013 2428.500000 181555.9400 74.7605
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 14 14.000000 654.5700 46.7550
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 191.7600 47.9400
AACFIT-92609TLGT-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 52 112.000000 13052.6800 116.5418
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 145 146.000000 7327.0000 50.1849
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 369 463.250000 23175.0000 50.0270
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 30 21.750000 1075.0000 49.4253
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 564 318.250000 15925.0000 50.0393
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.250000 6.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 166 201.250000 10118.8200 50.2799
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 917 625.750000 31337.6400 50.0801
CONOP-CONOP-CONSULT, OT, PHONE 5 4.250000 131.2500 30.8824
CONPF-CONPF-CONSULT, PT, FACE TO FACE 114 150.000000 7465.0000 49.7667
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 393 192.000000 9637.5000 50.1953
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 158 243.500000 12175.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 627 358.750000 17928.1600 49.9740
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1162 7352.500000 544.4300 0.0740
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 12.000000 600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 217 1840.000000 97823.0000 53.1647
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 107 418.000000 21976.0000 52.5742
EPIC-99601-Early Steps Professional Development Fee 941 5906.000000 88928.4300 15.0573
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 343 2764.000000 33180.0000 12.0043
OCCT-97530-OT SESSION BY LICENSED OT 124 1101.940000 76292.2400 69.2345
OCCT-97530GO-OT SESSION BY LICENSED OT 54 377.000000 30585.6200 81.1290
OCCT-97530GOGT-OT SESSION BY LICENSED OT 26 94.250000 7617.6100 80.8234
OCCT-97530GT-OT SESSION BY LICENSED OT 38 71.500000 5602.0000 78.3497
OCCT-97530HM-OT SESSION BY OT ASST 22 207.000000 14315.8400 69.1586
OCCT-97530HMGT-OT SESSION BY OT ASST 6 22.750000 1466.4400 64.4589
OCCT-97530TL-OT SESSION BY LICENSED OT 70 240.500000 17427.3300 72.4629
OCCT-97530TLGO-OT SESSION BY LICENSED OT 151 1382.740000 110345.9100 79.8024
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 45 102.750000 8168.4300 79.4981
OCCT-97530TLGT-OT SESSION BY LICENSED OT 11 14.000000 1026.1600 73.2971
OCCT-97530TLGTHM-OT SESSION BY OT ASST 18 33.000000 2148.9600 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 26 225.500000 14684.5600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 49 439.500000 34611.8200 78.7527
PHY-97110GT-PT SESSION BY LICENSED PT 10 15.000000 1147.2600 76.4840
PHY-97110TL-PT SESSION BY LICENSED PT 78 725.500000 57137.3600 78.7558
PHY-97110TLGT-PT SESSION BY LICENSED PT 23 46.750000 3642.5900 77.9164
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 115 835.340000 72168.6000 86.3943
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 35 102.500000 8834.9500 86.1946
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 76 443.250000 35090.3700 79.1661
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 51.750000 3969.6300 76.7078
Subtotal (Total Children Is Unduplicated) 1574 27683.02000 899634.1100 32.4977
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CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 2
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
Total 52483.020000 1902746.4100 36.2545
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Number of Children (Unduplicated) With at Least One Service 3331
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Center 54
Flag Claims Units Chgs Paid
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R 28 24.750000 1185.4200 55.8000
U 0 0.000000 0.0000 0.0000
B 3282 3146.500000 154832.0000 92856.0600
P 15907 14613.470000 733215.4600 723552.9800
D 2213 2037.330000 113213.6500 553.3800
S 116 120.200000 3784.8800 0.0000
H 155 165.270000 13105.3300 181.4800
T 16 16.000000 1301.1200 81.3200
40487 32120.750000 869902.4600 74.4000
Other 299 238.750000 12206.0900 1719.4500
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Total 62503 52483.020000 1902746.4100 819074.8700