CMS/EIP Fiscal Report Center: 53
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 2.000000 74.4000 37.2000
Subtotal (Total Children Is Unduplicated) 1 2.000000 74.4000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 3 3.000000 47.5200 15.8400
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 26.4300 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 202.4400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 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 7 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 44.500000 3337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 38.500000 2887.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 39 70.500000 3907.2500 55.4220
Subtotal (Total Children Is Unduplicated) 99 205.500000 12866.2400 62.6094
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 1083.2000 270.8000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 0.750000 37.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 5 4.000000 200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.750000 68.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 12.000000 600.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 230 1482.250000 74112.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 105 310.500000 15525.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 199 1233.000000 18495.0000 15.0000
INTR-T1013-INTERPRETER 2 1.500000 47.5800 31.7200
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 122 699.000000 8388.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 45 259.000000 18637.6400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 28 57.500000 4137.7000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 11 30.000000 2158.8000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 130.000000 9354.8000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 8.000000 575.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 16.000000 1151.3600 71.9600
TRAV-TRAVS-Travel by mile 316 29463.00000 13106.2700 0.4448
Subtotal (Total Children Is Unduplicated) 359 33724.75000 168280.1200 4.9898
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Total 33932.250000 181220.7600 5.3407
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Number of Children (Unduplicated) With at Least One Service 413
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Center 53
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4573 32121.928030 79415.3709 76648.7000
1750 1810.321970 101805.3891 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6323 33932.250000 181220.7600 76648.7000