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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1785 4993.250000 185748.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 6.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1972 7362.500000 273875.7000 37.1987
Subtotal (Total Children Is Unduplicated) 2168 12361.75000 459624.6000 37.1812
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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 200 357.500000 17875.0000 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 11 20.500000 1508.2500 73.5732
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 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 18 34.000000 1887.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 36.000000 2700.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 240 435.000000 32625.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 274 517.000000 38706.7500 74.8680
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 64 126.000000 9450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 40.500000 2247.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 478 882.000000 49029.0000 55.5884
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 5 5.000000 257.0500 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 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) 809 2948.500000 181319.7800 61.4956
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 153 253.000000 12650.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 41 66.750000 3312.5000 49.6255
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 99 132.500000 3387.5000 25.5660
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 28 32.000000 1600.0000 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 32 36.000000 1800.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 29.500000 1475.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 53 139.250000 0.5000 0.0036
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 23.000000 1150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1341 11225.00000 560865.1000 49.9657
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 81.000000 4050.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 829 7865.000000 47761.1900 6.0726
INTR-T1013-INTERPRETER 124 484.750000 24212.5000 49.9484
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 410 3467.000000 40829.7000 11.7767
OCCT-97530-OT SESSION BY LICENSED OT 160 1143.000000 81741.0500 71.5145
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 323 2760.750000 197436.0800 71.5154
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 14.000000 1007.4400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 503.7200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 1488 177745.0000 77536.8800 0.4362
Subtotal (Total Children Is Unduplicated) 1679 207237.2500 1183333.5900 5.7100
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Total 222547.500000 1824277.9700 8.1973
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Number of Children (Unduplicated) With at Least One Service 2298
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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 47057 210330.750000 1235705.8400 1235522.8800
D 87 397.250000 2881.5900 0.0000
S 0 0.000000 0.0000 0.0000
H 4189 4812.750000 209290.2900 184478.9400
T 9 7.750000 223.8200 223.8200
6653 6736.500000 358682.6800 358364.0800
Other 134 262.500000 17493.7500 150.0000
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Total 58129 222547.500000 1824277.9700 1778739.7200