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:EIP DEI DEIP
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 937 1358.750000 50545.4000 37.1999
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 33 26.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1097 2968.000000 110372.4000 37.1875
Subtotal (Total Children Is Unduplicated) 1221 4353.250000 160917.8000 36.9650
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
EXIT-EXIT-COS Exit 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 11.500000 862.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 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 8 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 40.500000 3037.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 50 89.500000 6712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 17.500000 1500.0000 85.7143
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 32 55.500000 4162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 22.500000 1687.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 38 64.000000 4987.5000 77.9297
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 27.000000 1498.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 103 182.500000 10128.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1687.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 25.500000 1912.5000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 7.000000 359.8700 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 13.000000 668.3300 51.4100
Subtotal (Total Children Is Unduplicated) 211 625.500000 42248.6100 67.5437
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 4 8.000000 575.6800 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 14 9.500000 475.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 13 12.250000 612.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 3.250000 162.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 128 121.000000 6050.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 37.750000 1887.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 107 100.000000 5025.0000 50.2500
CONPF-CONPF-CONSULT, PT, FACE TO FACE 40 79.500000 3975.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 145 83.500000 4175.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 25 11.000000 275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 54 72.250000 3612.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 177 132.750000 6637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 13 12.000000 300.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 425 1501.250000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 143 615.000000 30750.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 69 124.000000 6200.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 357 1793.000000 26895.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 105 339.000000 4068.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 55.000000 4133.8800 75.1615
OCCT-97530GT-OT SESSION BY LICENSED OT 3 18.500000 1331.2600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 40 199.000000 14320.0400 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 2 12.000000 863.5200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 17 52.250000 3759.9100 71.9600
PHY-97110-PT SESSION BY LICENSED PT 32 171.250000 14507.6700 84.7163
PHY-97110GT-PT SESSION BY LICENSED PT 12 13.750000 1493.5700 108.6233
PHY-97110TL-PT SESSION BY LICENSED PT 43 270.250000 19651.2100 72.7149
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 3.250000 233.8700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 210.500000 15983.4200 75.9307
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 16.750000 1469.4500 87.7284
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 74 331.000000 23818.7600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 22 44.500000 3202.2200 71.9600
Subtotal (Total Children Is Unduplicated) 529 6458.000000 206637.3700 31.9971
-----------------------------------------------------------------------------------------------------------------------
Total 11436.750000 409803.7800 35.8322
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1260
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5 4.000000 224.4000 0.0000
P 4026 3810.750000 199552.8100 196097.8700
D 784 716.000000 44303.3000 0.0000
S 3 2.000000 135.2300 0.0000
H 16 8.500000 350.9600 0.0000
T 0 0.000000 0.0000 0.0000
9544 6876.250000 163994.3700 0.0000
Other 20 19.250000 1242.7100 0.0000
---------------------------------------------------------
Total 14398 11436.750000 409803.7800 196097.8700