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:OTHER
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 56 83.000000 3087.6000 37.2000
Subtotal (Total Children Is Unduplicated) 56 83.000000 3087.6000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 16 25.000000 1250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.000000 1125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 39.000000 2925.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 61 105.000000 7875.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 21.000000 1165.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 65 104.000000 5772.0000 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 6.000000 300.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 14 51.000000 2550.0000 50.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 19.000000 976.7900 51.4100
Subtotal (Total Children Is Unduplicated) 152 405.000000 25322.2900 62.5242
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 41 66.000000 3300.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 6 8.500000 425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 43 47.500000 1187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 3.000000 100.0000 33.3333
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 15.000000 750.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 6.000000 300.0000 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 402 2111.000000 105500.1000 49.9764
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 8.000000 400.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 428 2364.000000 11144.7800 4.7144
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 191 853.000000 10236.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 71 405.750000 28688.5400 70.7050
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 73 406.000000 29225.1200 71.9831
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 142 732.500000 52248.0100 71.3283
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 885 54337.00000 23733.6700 0.4368
Subtotal (Total Children Is Unduplicated) 973 61378.25000 268073.5200 4.3676
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Total 61866.250000 296483.4100 4.7923
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Number of Children (Unduplicated) With at Least One Service 1066
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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 12063 61616.250000 282482.9900 282482.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 168 249.000000 13919.1000 0.0000
T 1 1.000000 81.3200 81.3200
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 12232 61866.250000 296483.4100 282564.3100