CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1683 4805.750000 178773.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 6.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 927 3439.500000 127949.4000 37.2000
Subtotal (Total Children Is Unduplicated) 1858 8251.250000 306723.3000 37.1730
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 184 332.500000 16625.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.500000 683.2500 71.9211
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 67.000000 5025.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 86.500000 6487.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 8.000000 600.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 68 132.500000 7353.7500 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 5 20.000000 1000.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 23 123.000000 6150.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 44.000000 2262.0400 51.4100
Subtotal (Total Children Is Unduplicated) 319 835.500000 46940.3600 56.1824
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 118 187.000000 9350.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 36 58.250000 2887.5000 49.5708
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 59 85.000000 2200.0000 25.8824
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 25 28.000000 1400.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 21.000000 1050.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 14.000000 700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 23.500000 1175.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 51 131.500000 0.5000 0.0038
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 22.000000 1100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 551 3187.000000 159250.0000 49.9686
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 27.000000 1350.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 766 5501.000000 36616.4100 6.6563
INTR-T1013-INTERPRETER 114 467.500000 23350.0000 49.9465
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 370 2614.000000 30593.7000 11.7038
OCCT-97530-OT SESSION BY LICENSED OT 37 169.750000 12215.2100 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 28 169.500000 12055.4900 71.1238
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 349.750000 25194.7500 72.0365
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 1332 123304.0000 53757.4700 0.4360
Subtotal (Total Children Is Unduplicated) 1486 136368.7500 374780.8300 2.7483
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Total 145455.500000 728444.4900 5.0080
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Number of Children (Unduplicated) With at Least One Service 2077
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Center 09
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 31546 145084.250000 727504.3200 727504.3200
D 51 365.000000 779.0700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 5.750000 142.5000 142.5000
2 0.500000 18.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 31606 145455.500000 728444.4900 727646.8200