CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:GR
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 896 1014.000000 37711.5000 37.1908
TCM-T1017TL-TARGETED CASE MANAGEMENT 639 4192.500000 156491.1000 37.3264
Subtotal (Total Children Is Unduplicated) 1177 5206.500000 194202.6000 37.3000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 11 29.500000 1475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 352.4500 78.3222
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.000000 701.9100 77.9900
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 271.4700 77.5629
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 10 17.000000 987.7000 58.1000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.000000 284.1300 56.8260
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.500000 1021.4700 75.6644
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 805.4400 76.7086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 892.4000 77.6000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 233.9700 77.9900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 36.000000 2033.3600 56.4822
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 292.9700 58.5940
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 9.000000 502.8900 55.8767
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 753.2400 53.8029
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 167.6300 55.8767
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 219.0400 54.7600
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 257.0500 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 16.000000 896.2600 56.0163
Subtotal (Total Children Is Unduplicated) 80 211.000000 12987.1300 61.5504
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2757.7200 2757.7200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 17.000000 850.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 274 414.000000 20700.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 121 145.000000 7250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 22 38.000000 1900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 17 22.000000 1100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 512 761.000000 38050.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 206 332.000000 16600.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 579 14377.75000 755246.5000 52.5288
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 27 116.000000 6076.0000 52.3793
EPIC-99601-Early Steps Professional Development Fee 1098 28461.00000 426867.0000 14.9983
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 658 10723.00000 128700.0000 12.0022
OCCT-97530-OT SESSION BY LICENSED OT 13 154.500000 12063.1800 78.0788
OCCT-97530HM-OT SESSION BY OT ASST 3 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 7 71.750000 5677.9300 79.1349
PHY-97110GPGT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 8 73.500000 5593.2600 76.0988
PHY-97110HM-PT SESSION BY PT ASST 8 66.000000 4108.9200 62.2564
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 25.500000 1863.0600 73.0612
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 359.8000 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 25.500000 1468.8000 57.6000
TRAV-TRAVS-Travel by mile 9 10594.00000 4714.2100 0.4450
Subtotal (Total Children Is Unduplicated) 1439 66431.50000 1442463.1400 21.7135
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Total 71849.000000 1649652.8700 22.9600
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Number of Children (Unduplicated) With at Least One Service 1576
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Center 57
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 0 0.000000 0.0000 0.0000
D 638 643.500000 16569.8700 0.0000
S 0 0.000000 0.0000 0.0000
H 9 11.500000 3148.3200 3148.3200
T 53738 63862.000000 1372615.1100 1372615.1100
7837 7332.000000 257319.5700 18.6000
Other 0 0.000000 0.0000 0.0000
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Total 62222 71849.000000 1649652.8700 1375782.0300