CMS/EIP Fiscal Report Center: 54
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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 210 123.500000 4594.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 27 18.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 225 523.500000 19455.6000 37.1645
Subtotal (Total Children Is Unduplicated) 377 665.750000 24049.8000 36.1244
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
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 4 7.500000 607.3500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 12.000000 719.0400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
Subtotal (Total Children Is Unduplicated) 20 51.000000 3620.9800 70.9996
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 15.000000 5877.3300 391.8220
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 37 42.750000 2137.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 132 146.500000 7312.5000 49.9147
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 26.000000 1300.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 66 32.500000 1625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 6.500000 162.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 5.250000 262.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 106 58.250000 2912.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 75.0000 37.5000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 8.250000 412.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 53 24.500000 1225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 16.000000 800.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 74 35.500000 1775.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 255 1005.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 76 368.000000 19872.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 57.500000 3105.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 395 2229.000000 33435.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 240 1198.000000 14376.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 54.000000 4391.2800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 8 23.000000 1870.3600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 212.6400 70.8800
OCCT-97530HM-OT SESSION BY OT ASST 4 18.000000 1172.1600 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 195.3600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 20 67.500000 5489.1000 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 77.750000 6322.6300 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 382 31865.00000 14175.4100 0.4449
Subtotal (Total Children Is Unduplicated) 600 37396.25000 131157.3300 3.5072
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Total 38113.000000 158828.1100 4.1673
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Number of Children (Unduplicated) With at Least One Service 693
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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 72 54.000000 2819.2900 0.0000
S 4 3.250000 133.9300 0.0000
H 0 0.000000 0.0000 0.0000
T 2680 19597.500000 42391.0300 42391.0300
6308 18456.000000 113400.1600 0.0000
Other 4 2.250000 83.7000 0.0000
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Total 9068 38113.000000 158828.1100 42391.0300