CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 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
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 9 8.500000 425.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 33 63.500000 4002.3900 63.0298
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 29 32.250000 1612.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 24 26.500000 1325.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 73 81.250000 4063.0000 50.0062
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 21 20.000000 1000.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 26.500000 1325.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 24 22.000000 1100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 6.500000 325.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 11 8.250000 412.5000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 97 550.500000 27525.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 81.000000 4050.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 240 1735.000000 26025.0000 15.0000
INTR-T1013-INTERPRETER 15 68.500000 3425.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 156 819.000000 9783.0000 11.9451
OCCT-97530-OT SESSION BY LICENSED OT 14 56.750000 4083.7300 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 10.000000 719.6000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 9 21.000000 1511.1600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 28.000000 1906.9400 68.1050
TRAV-TRAVS-Travel by mile 105 8036.000000 3575.4200 0.4449
Subtotal (Total Children Is Unduplicated) 412 11630.50000 93830.3500 8.0676
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Total 11694.000000 97832.7400 8.3661
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Number of Children (Unduplicated) With at Least One Service 413
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Center 02
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4014 11693.000000 97820.7400 97945.4700
1 1.000000 12.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4015 11694.000000 97832.7400 97945.4700