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
Agency Filter:EXT
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 5 2.000000 74.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 124 165.750000 6165.9000 37.2000
Subtotal (Total Children Is Unduplicated) 125 167.750000 6240.3000 37.2000
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Screening, Eval, and Assessment,Class #02
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) 57 61.000000 3113.6900 51.0441
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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 24832.750000 832913.2300 33.5409
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Number of Children (Unduplicated) With at Least One Service 1376
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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 22 14.750000 548.7000 0.0000
P 15842 15454.750000 364700.1500 350657.3100
D 2 0.750000 27.9000 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
593 447.500000 17692.9800 0.0000
Other 291 188.500000 8923.3800 -854.0000
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Total 25521 24832.750000 832913.2300 349803.3100