CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
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 689 717.250000 26681.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1471 6146.000000 228492.7000 37.1775
Subtotal (Total Children Is Unduplicated) 1499 6863.250000 255174.4000 37.1798
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 6 5.250000 262.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 19.500000 1462.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 138.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 37.500000 2812.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 131 186.500000 13987.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 96 135.500000 10162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 59.500000 3302.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 219 438.500000 24336.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 59.500000 4462.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 152 278.000000 20850.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 67 67.000000 9203.3500 137.3634
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 18 18.000000 882.5100 49.0283
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 16 16.000000 843.1100 52.6944
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 17 17.000000 873.9700 51.4100
Subtotal (Total Children Is Unduplicated) 383 1405.250000 97454.7600 69.3505
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 39.000000 1950.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 38 285.000000 7125.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1175 11297.50000 564875.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 154.500000 7725.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 845 8413.000000 126195.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 390 3289.000000 39468.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 253.000000 18229.2800 72.0525
OCCT-97530HM-OT SESSION BY OT ASST 16 107.500000 6192.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 14.000000 1007.4400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 62 287.000000 20692.1200 72.0980
PHY-97110HM-PT SESSION BY PT ASST 23 204.000000 11731.3600 57.5067
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 243.000000 17519.0400 72.0948
Subtotal (Total Children Is Unduplicated) 1308 24604.00000 823559.2400 33.4726
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Total 32872.500000 1176188.4000 35.7803
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Number of Children (Unduplicated) With at Least One Service 1830
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Center 04
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 382 644.500000 26064.4500 0.0000
P 17834 18961.250000 508044.1000 496516.3700
D 38 52.500000 2289.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 8771 8726.500000 441020.1200 0.0000
T 0 0.000000 0.0000 0.0000
3593 4298.250000 189809.5500 0.0000
Other 292 189.500000 8960.5800 -854.0000
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Total 30910 32872.500000 1176188.4000 495662.3700