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
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 2 3.250000 120.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 2.250000 83.7000 37.2000
Subtotal (Total Children Is Unduplicated) 3 5.500000 204.6000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 14 28.000000 1400.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 39.500000 2962.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 35 69.000000 5175.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 51.000000 2830.5000 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
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 44.000000 2262.0400 51.4100
Subtotal (Total Children Is Unduplicated) 121 387.500000 22731.4500 58.6618
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 108 171.500000 8575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 16 22.500000 1125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 46 68.000000 1775.0000 26.1029
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 19 22.000000 1100.0000 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 18 20.000000 1000.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 12.000000 600.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 18 20.500000 1025.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 21.000000 1050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 540 3135.000000 156650.0000 49.9681
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
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 370 2614.000000 30593.7000 11.7038
OCCT-97530-OT SESSION BY LICENSED OT 35 168.000000 12089.2800 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 57 343.750000 24762.9900 72.0378
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 1317 122346.0000 53401.8500 0.4365
Subtotal (Total Children Is Unduplicated) 1399 134670.7500 344304.5200 2.5566
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Total 135063.750000 367240.5700 2.7190
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Number of Children (Unduplicated) With at Least One Service 1442
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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 21943 134696.750000 366458.5000 366458.5000
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 2 2.000000 3.0000 3.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 21996 135063.750000 367240.5700 366461.5000