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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 99 147.000000 5468.4000 37.2000
Subtotal (Total Children Is Unduplicated) 99 147.000000 5468.4000 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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 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 3 5.500000 305.2500 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 47 75.500000 5662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 80 137.000000 10275.0000 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 26 40.500000 2247.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 103 165.000000 9157.5000 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) 214 581.500000 36960.7900 63.5611
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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 886 54389.00000 23756.5400 0.4368
Subtotal (Total Children Is Unduplicated) 974 61430.25000 268096.3900 4.3642
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Total 62158.750000 310525.5800 4.9957
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Number of Children (Unduplicated) With at Least One Service 1129
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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 12089 61716.750000 285763.1100 285763.1100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 297 441.000000 24681.1500 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 12387 62158.750000 310525.5800 285844.4300