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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2548 3687.000000 138980.9500 37.6949
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 331 352.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2767 24750.00000 925007.6500 37.3740
Subtotal (Total Children Is Unduplicated) 2806 28789.50000 1063988.6000 36.9575
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 154 304.000000 24055.8000 79.1309
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 30 60.000000 4751.1600 79.1860
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 22.000000 1697.8400 77.1745
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 40 80.000000 6310.9600 78.8870
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 87 168.500000 9919.7200 58.8707
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 17 36.000000 2139.4400 59.4289
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 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 1120 2257.000000 179315.4200 79.4486
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 186 379.000000 30141.2600 79.5284
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 222 443.999999 35211.4400 79.3050
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 47 95.000000 7585.4600 79.8469
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 310 620.000000 49430.2000 79.7261
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 78.000000 6160.9600 78.9867
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 539 1078.000000 63303.1200 58.7227
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 122 244.000000 14408.3200 59.0505
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) 1730 6244.251719 456197.5525 73.0588
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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 701 10276.00000 154140.0000 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 2 140.000000 62.3000 0.4450
Subtotal (Total Children Is Unduplicated) 1388 49422.93611 2032037.9792 41.1153
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Total 84456.687830 3552224.1317 42.0597
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Number of Children (Unduplicated) With at Least One Service 2818
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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 8783 9193.000000 410943.5300 46.5000
P 38270 38128.451642 1292022.4425 1291301.2200
D 4 6.250000 320.0600 0.0000
S 0 0.000000 0.0000 0.0000
H 215 401.000000 31802.9600 0.0000
T 2271 2190.652618 67049.1700 67049.1700
39488 34537.333570 1750085.9692 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 89031 84456.687830 3552224.1317 1358396.8900