CMS/EIP Fiscal Report Center: 55
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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 2130 3304.250000 124742.6500 37.7522
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 301 318.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2244 21462.50000 802731.2500 37.4016
Subtotal (Total Children Is Unduplicated) 2280 25084.75000 927473.9000 36.9736
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 123 242.000000 19166.6000 79.2008
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 26 52.000000 4127.2400 79.3700
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 16.000000 1235.8800 77.2425
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 635.8800 79.4850
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 30 60.000000 4751.1600 79.1860
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 461.9600 76.9933
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 69 132.500000 7806.8000 58.9192
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 34.000000 2019.6000 59.4000
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 735 1477.000000 117442.7000 79.5144
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 125 256.000000 20312.2800 79.3448
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 148 295.999999 23465.6000 79.2757
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 32 65.000000 5179.9800 79.6920
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 207 414.000000 32939.6800 79.5644
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 29 58.000000 4589.2000 79.1241
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 350 698.000000 41063.9200 58.8308
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 81 162.000000 9547.9200 58.9378
OCTF-97168-OT RE-EVAL EST PLAN CARE 80 93.001720 5297.1300 56.9573
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 14 15.000000 844.8500 56.3233
OCTH-97167-OT EVAL HIGH COMPLEXITY 89 90.000000 5080.3100 56.4479
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 43 49.000000 2773.6900 56.6059
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 26 27.000000 1508.6700 55.8767
PSTH-97163-PT EVAL HIGH COMPLEXITY 15 15.000000 844.8500 56.3233
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 60 62.750000 3478.9025 55.4407
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 1238 4339.251719 315253.0525 72.6515
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 242.8000 121.4000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 39 41.750000 2087.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 5 4.000000 200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 6.750000 168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 231 351.500000 17575.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 23 25.000000 1250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 152 283.000000 7075.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 74 213.500000 10450.0000 48.9461
CONOP-CONOP-CONSULT, OT, PHONE 49 278.000000 6950.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 214 334.500000 16700.0000 49.9253
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 19 21.000000 1050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 149 281.500000 7037.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 684 11202.25000 592687.5000 52.9079
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 61 355.250000 19007.5000 53.5046
EPIC-99601-Early Steps Professional Development Fee 700 10275.00000 154125.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 750 11097.00000 133229.9600 12.0059
OCCT-97530-OT SESSION BY LICENSED OT 158 2065.750005 162345.3000 78.5890
OCCT-97530GT-OT SESSION BY LICENSED OT 2 8.000000 650.5600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 193 3225.319835 203555.4800 63.1117
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 96 1484.875085 112942.4500 76.0619
PHY-97110HM-PT SESSION BY PT ASST 89 1535.103548 96537.0492 62.8863
PHY-97110HMGT-PT SESSION BY PT ASST 2 4.750000 309.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 418 5787.887638 454090.9200 78.4554
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 81.500000 6608.8600 81.0903
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 28 313.750000 24896.3900 79.3510
TRAV-TRAVS-Travel by mile 1 70.000000 31.1500 0.4450
Subtotal (Total Children Is Unduplicated) 1387 49351.93611 2031991.8292 41.1735
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Total 78775.937830 3274718.7817 41.5700
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Number of Children (Unduplicated) With at Least One Service 2292
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Center 55
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 8242 8093.750000 354785.9500 46.5000
P 37679 36968.397376 1228802.4325 1228256.9700
D 1 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 152 276.000000 21956.0600 0.0000
T 2263 2174.652618 65753.4900 65753.4900
36475 31262.387836 1603392.9492 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 84812 78775.937830 3274718.7817 1294056.9600