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
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 957 923.750000 34354.2000 37.1899
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 137 115.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 811 3794.000000 140987.8000 37.1607
Subtotal (Total Children Is Unduplicated) 1330 4832.750000 175342.0000 36.2820
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 32 34.000000 1649.0000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 461.9600 76.9933
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 14.000000 1097.8400 78.4171
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.500000 431.7200 57.5627
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 646.4700 76.0553
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 842.9400 76.6309
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.000000 803.8200 80.3820
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 15 29.500000 2281.2700 77.3312
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2162.0400 56.8958
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1223.9200 76.4950
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 911.9600 75.9967
Subtotal (Total Children Is Unduplicated) 103 199.000000 13462.2400 67.6494
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 132.7600 44.2533
ASST-ASST-ASSISTIVE TECHNOLOGY 27 63.000000 9497.3600 150.7517
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 90 102.250000 5162.5000 50.4890
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 266 374.250000 18750.0000 50.1002
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 21 15.750000 787.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 305 183.250000 9187.5000 50.1364
CONOF-CONOF-CONSULT, OT, FACE TO FACE 140 173.750000 8743.8200 50.3241
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 518 369.500000 18425.0000 49.8647
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 75.0000 37.5000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 79 112.500000 5590.0000 49.6889
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 219 112.000000 5600.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 135 210.750000 10537.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 377 228.250000 11415.6600 50.0138
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 712 5311.250000 372.9600 0.0702
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 224.000000 11772.0000 52.5536
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 22 87.000000 4550.0000 52.2989
EPIC-99601-Early Steps Professional Development Fee 574 4327.000000 65089.9600 15.0427
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 227 2012.000000 24156.0000 12.0060
OCCT-97530-OT SESSION BY LICENSED OT 36 295.000000 23034.6800 78.0837
OCCT-97530GO-OT SESSION BY LICENSED OT 17 91.000000 7312.6600 80.3589
OCCT-97530GOGT-OT SESSION BY LICENSED OT 10 40.250000 3263.7700 81.0875
OCCT-97530GT-OT SESSION BY LICENSED OT 8 21.750000 1596.9900 73.4248
OCCT-97530HM-OT SESSION BY OT ASST 6 72.000000 4636.0000 64.3889
OCCT-97530HMGT-OT SESSION BY OT ASST 1 7.000000 448.3200 64.0457
OCCT-97530TL-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 2 3.000000 234.6000 78.2000
PHY-97110-PT SESSION BY LICENSED PT 23 219.880000 17096.6400 77.7544
PHY-97110GT-PT SESSION BY LICENSED PT 4 8.880000 668.2000 75.2477
PHY-97110TL-PT SESSION BY LICENSED PT 2 4.000000 325.2800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 342.000000 26390.1800 77.1643
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 42.000000 3249.3000 77.3643
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 3.500000 284.6200 81.3200
Subtotal (Total Children Is Unduplicated) 946 15073.76000 299071.5600 19.8405
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Total 20105.510000 487875.8000 24.2658
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Number of Children (Unduplicated) With at Least One Service 1468
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Center 54
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 522 384.010000 18025.8900 37.5000
S 59 65.000000 447.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
24595 19628.000000 468220.3800 0.0000
Other 38 28.500000 1182.5300 0.0000
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Total 25214 20105.510000 487875.8000 37.5000