CMS/EIP Fiscal Report Center: 55
Services beginning 04/01/2025 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 971 867.250000 33173.1000 38.2509
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 94 101.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1222 5372.500000 204322.7500 38.0312
Subtotal (Total Children Is Unduplicated) 1257 6340.750000 237495.8500 37.4555
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 37 74.000000 5992.5200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 20.000000 1619.6000 80.9800
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 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 971.7600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 12 22.000000 1318.2400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
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 173 345.000000 27938.1000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 60.000000 4858.8000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 52.000000 4210.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 809.8000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 92.000000 7450.1600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 76 152.000000 9107.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 52.000000 3115.8400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 21 21.000000 1220.3100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 18 18.000000 1045.9800 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 406.7700 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 639.2100 58.1100
Subtotal (Total Children Is Unduplicated) 315 971.000000 72373.4600 74.5350
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.500000 175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 55 54.500000 2725.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 69 57.500000 1437.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 44.000000 2200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 28 52.000000 1300.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 52 51.500000 2575.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 67 55.500000 1387.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 368 2274.750000 122836.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 21 85.000000 4590.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 421 2371.000000 35565.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 308 1799.000000 21588.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 74 360.000000 29275.2000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 103 632.250000 41172.1200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 52 307.000000 24965.2400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 58 311.249986 20268.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 203 994.250000 80852.4100 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 29.500000 2398.9400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 16 91.750000 7461.1100 81.3200
Subtotal (Total Children Is Unduplicated) 783 9577.249986 402960.7600 42.0748
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Total 16888.999986 712830.0700 42.2068
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Number of Children (Unduplicated) With at Least One Service 1300
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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 3287 3282.250000 143680.1500 0.0000
P 4025 3959.715722 123136.2800 123136.2800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 36 67.000000 5427.3600 0.0000
T 2173 2098.592728 62354.2600 62354.2600
8720 7481.441536 378232.0200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18241 16888.999986 712830.0700 185490.5400