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: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 1084 957.500000 36530.4000 38.1519
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 115 124.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1385 6276.750000 237951.5500 37.9100
Subtotal (Total Children Is Unduplicated) 1428 7359.000000 274481.9500 37.2988
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 43 86.000000 6964.2800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 22.000000 1781.5600 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 7 14.000000 1133.7200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 17 32.000000 1917.4400 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 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 286 571.000000 46239.5800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 46 94.000000 7612.1200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 47 94.000000 7612.1200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 78 156.000000 12632.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 971.7600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 114 228.000000 13661.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 43 86.000000 5153.1200 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) 455 1487.000000 111589.8200 75.0436
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 18423.249986 789032.5300 42.8281
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1471
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3513 3773.000000 169029.4500 0.0000
P 4062 4033.715722 128791.8400 128791.8400
D 1 1.500000 55.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 58 111.000000 8990.4800 0.0000
T 2181 2114.592728 63649.9400 63649.9400
9477 8389.441536 418515.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19292 18423.249986 789032.5300 192441.7800