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
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 651 446.000000 16581.9000 37.1791
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 91 73.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1632 5266.250000 196202.1000 37.2565
Subtotal (Total Children Is Unduplicated) 1683 5785.750000 212784.0000 36.7773
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 350.4900 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 233.6600 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.000000 566.8600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 25.000000 1943.5200 77.7408
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.500000 1093.2300 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 49.500000 4008.5100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.500000 2550.8700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 58 108.500000 8883.8800 81.8791
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 58 103.500000 8381.4300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 8.000000 826.3700 103.2963
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 29.500000 2388.9100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 26.000000 1498.0000 57.6154
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 40 77.500000 4643.8000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 81.000000 6559.3800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 35.500000 2874.7900 80.9800
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 280 633.000000 48828.5000 77.1382
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 143.8200 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
AACFIT-92609TLGT-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 12 23.000000 6629.4800 288.2383
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 32.000000 1600.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 125 122.000000 6087.5000 49.8975
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 6.000000 300.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 166 68.750000 3425.0000 49.8182
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.250000 6.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 9.750000 487.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 307 170.750000 8593.8200 50.3298
CONOP-CONOP-CONSULT, OT, PHONE 4 4.000000 125.0000 31.2500
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 19.500000 975.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 137 59.500000 3000.0000 50.4202
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 25.250000 1262.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 195 91.500000 4562.5000 49.8634
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 550 1955.250000 121.4700 0.0621
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 120 471.750000 25470.5000 53.9915
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 33 56.000000 3024.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 420 1547.000000 23311.4700 15.0688
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 146 673.000000 8076.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 52 253.000000 21363.4000 84.4403
OCCT-97530GO-OT SESSION BY LICENSED OT 33 159.000000 13029.5600 81.9469
OCCT-97530GOGT-OT SESSION BY LICENSED OT 9 18.000000 1463.7600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 12 21.000000 1676.4000 79.8286
OCCT-97530HM-OT SESSION BY OT ASST 16 82.000000 6288.6400 76.6907
OCCT-97530HMGT-OT SESSION BY OT ASST 4 8.000000 520.9600 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 80 414.000000 33666.4800 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 12 41.000000 3334.1200 81.3200
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 10 14.000000 911.6800 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 18 80.500000 5242.1600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 31 94.500000 7684.7400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.250000 101.6500 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 42 170.500000 13865.0600 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 9 11.500000 935.1800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 202.500000 16943.3400 83.6708
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 23.750000 1931.3500 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 45 122.750000 9982.0300 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 9.500000 772.5400 81.3200
Subtotal (Total Children Is Unduplicated) 770 7070.500000 237210.8800 33.5494
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Total 13489.250000 498823.3800 36.9793
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Number of Children (Unduplicated) With at Least One Service 1726
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Center 54
Flag Claims Units Chgs Paid
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R 27 23.750000 1104.1000 55.8000
U 0 0.000000 0.0000 0.0000
B 2976 2851.250000 140560.3200 89880.0300
P 1892 1739.070000 90810.4400 89359.9800
D 421 330.480000 18868.3400 0.0000
S 14 11.450000 699.3200 0.0000
H 116 127.250000 10058.1100 181.4800
T 11 11.000000 894.5200 81.3200
10237 8336.000000 232943.5500 74.4000
Other 85 59.000000 2884.6800 874.0700
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Total 15779 13489.250000 498823.3800 180507.0800