CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2025 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 2.250000 83.7000 37.2000
Subtotal (Total Children Is Unduplicated) 2 2.250000 83.7000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 3 3.000000 174.3300 58.1100
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 4.750000 237.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 44.000000 2200.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 17 17.000000 850.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 75 77.000000 3850.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 71 71.000000 3550.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 221 2298.000000 124092.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 14.000000 756.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 492 5023.000000 75345.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 120 1075.000000 12924.0000 12.0223
OCCT-97530-OT SESSION BY LICENSED OT 3 24.000000 1951.6800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 5 17.500000 1423.1000 81.3200
PHY-97110GPGT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 14.000000 911.6800 65.1200
TRAV-TRAVS-Travel by mile 4 1842.000000 819.6600 0.4450
Subtotal (Total Children Is Unduplicated) 595 10532.25000 229617.2200 21.8013
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Total 10537.500000 229875.2500 21.8150
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Number of Children (Unduplicated) With at Least One Service 599
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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 118 123.500000 3104.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 6642 8455.750000 174196.7100 174196.7100
1965 1958.250000 52573.9400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8725 10537.500000 229875.2500 174196.7100