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
Agency Filter:EXT
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 40 29.000000 1078.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 119.750000 4454.7000 37.2000
Subtotal (Total Children Is Unduplicated) 85 148.750000 5533.5000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
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) 34 58.000000 3199.8000 55.1690
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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 18 31.000000 1550.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 10 11.000000 550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 511 760.000000 38000.0000 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 28459.00000 426837.0000 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 66410.50000 1441483.1400 21.7057
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Total 66617.250000 1450216.4400 21.7694
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Number of Children (Unduplicated) With at Least One Service 1476
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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 635 640.500000 16489.8700 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 2757.7200 2757.7200
T 53738 63862.000000 1372615.1100 1372615.1100
2121 2113.750000 58353.7400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 56495 66617.250000 1450216.4400 1375372.8300