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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 2 2.000000 31.6800 15.8400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 86.7600 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
Subtotal (Total Children Is Unduplicated) 14 28.500000 1416.2300 49.6923
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 541.6000 180.5333
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 318.250000 15912.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 22 41.500000 2075.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 199 1232.000000 18480.0000 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 5 12.735690 916.4600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 18.000000 1295.2800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 316 29463.00000 13106.2700 0.4448
Subtotal (Total Children Is Unduplicated) 326 31815.98569 62028.4000 1.9496
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Total 31844.485690 63444.6300 1.9923
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Number of Children (Unduplicated) With at Least One Service 333
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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 4299 31844.485690 63444.6300 61890.6000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4299 31844.485690 63444.6300 61890.6000