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
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 2 3.250000 120.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 56 90.000000 3348.0000 37.2000
Subtotal (Total Children Is Unduplicated) 56 93.250000 3468.9000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 17.6200 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
EXIT-EXIT-COS Exit 30 53.000000 2650.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 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 5 10.000000 555.0000 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 84 158.500000 11887.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 160 301.500000 22612.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 46.000000 3450.0000 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 159 284.500000 15828.7500 55.6371
NUTR-97802-NUTRITIONAL EVAL, INITIAL 7 30.000000 1500.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 26 186.000000 9300.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 28 232.000000 11207.3800 48.3077
Subtotal (Total Children Is Unduplicated) 433 1380.500000 84031.8200 60.8706
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 143 237.500000 11875.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 21 31.000000 1550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 87 115.500000 2962.5000 25.6494
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 26.000000 1300.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 5.000000 200.0000 40.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 31 35.000000 1750.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 16.000000 800.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 26.500000 1325.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 22.000000 1100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1307 11048.00000 552015.1000 49.9652
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 78.000000 3900.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 829 7865.000000 47761.1900 6.0726
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 410 3467.000000 40829.7000 11.7767
OCCT-97530-OT SESSION BY LICENSED OT 153 1118.500000 79978.0300 71.5047
OCCT-97530GT-OT SESSION BY LICENSED OT 12 14.000000 1007.4400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 9 25.000000 1440.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 6 14.000000 1007.4400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 167 1647.750000 116927.7900 70.9621
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 311 2708.250000 193658.1800 71.5068
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 12.000000 863.5200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 503.7200 71.9600
TRAV-TRAVS-Travel by mile 1471 176683.0000 77135.5200 0.4366
Subtotal (Total Children Is Unduplicated) 1602 205208.0000 1140206.0100 5.5563
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Total 206681.750000 1227706.7300 5.9401
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Number of Children (Unduplicated) With at Least One Service 1748
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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 36862 199118.000000 840687.8900 840504.9300
D 87 397.250000 2881.5900 0.0000
S 0 0.000000 0.0000 0.0000
H 168 249.000000 13919.1000 0.0000
T 4 4.000000 84.3200 84.3200
6633 6701.000000 356117.0800 355817.0800
Other 108 212.500000 14016.7500 0.0000
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Total 43862 206681.750000 1227706.7300 1196406.3300