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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 206.250000 7672.5000 37.2000
Subtotal (Total Children Is Unduplicated) 89 206.250000 7672.5000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 440.5600 58.7413
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.000000 1192.0200 56.7629
OCTF-97168-OT RE-EVAL EST PLAN CARE 19 19.000000 1010.2900 53.1732
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 616.9200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 11 14.000000 766.6400 54.7600
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.000000 431.3800 53.9225
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 29 32.000000 1692.0200 52.8756
Subtotal (Total Children Is Unduplicated) 62 120.000000 6535.0500 54.4588
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 892 23615.50000 1243491.0000 52.6557
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 41 242.000000 12796.0000 52.8760
OCCT-97530-OT SESSION BY LICENSED OT 52 611.000000 45797.4400 74.9549
OCCT-97530HM-OT SESSION BY OT ASST 35 205.000000 12304.3200 60.0211
OCCT-97530TL-OT SESSION BY LICENSED OT 4 7.500000 539.7000 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 1 7.000000 433.2800 61.8971
PHY-97110-PT SESSION BY LICENSED PT 14 155.000000 11408.6800 73.6044
PHY-97110HM-PT SESSION BY PT ASST 34 430.000000 25975.1900 60.4074
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 432.500000 32388.0600 74.8857
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 43 284.500000 17103.7400 60.1186
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.500000 251.8600 71.9600
Subtotal (Total Children Is Unduplicated) 944 25995.50000 1402651.9100 53.9575
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Total 26321.750000 1416859.4600 53.8285
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Number of Children (Unduplicated) With at Least One Service 965
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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 2 2.000000 104.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 227 206.250000 7672.5000 7672.5000
T 0 0.000000 0.0000 0.0000
26326 26113.500000 1409082.9600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 26555 26321.750000 1416859.4600 7672.5000