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
Payclass Filters:GR
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 384 332.000000 12350.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 58 65.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 240 785.250000 29185.1500 37.1667
Subtotal (Total Children Is Unduplicated) 442 1182.750000 41535.5500 35.1178
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 18.000000 1457.6400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 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 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 15.000000 898.8000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 31 69.000000 5096.0000 73.8551
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.500000 75.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 18 18.000000 900.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 33 27.500000 687.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 21.000000 1050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 14 30.000000 750.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 15.000000 750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 32 26.500000 662.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 65 343.750000 18562.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 8.500000 459.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 230 1370.000000 20550.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 152 923.000000 11076.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 63.534804 5166.6500 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 13 65.805896 4285.2800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 11 48.713232 3961.3600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 15 67.193788 4375.6600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 128.923757 10484.0800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
Subtotal (Total Children Is Unduplicated) 352 3162.921477 84120.8100 26.5959
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Total 4414.671477 130752.3600 29.6177
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Number of Children (Unduplicated) With at Least One Service 514
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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 0 0.000000 0.0000 0.0000
P 2066 2016.968474 53703.8600 53703.8600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1036 996.739771 27097.0700 27097.0700
1882 1400.963232 49951.4300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4984 4414.671477 130752.3600 80800.9300