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
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 1008 1469.000000 54646.7000 37.1999
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 39 30.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1191 3367.250000 125224.5000 37.1890
Subtotal (Total Children Is Unduplicated) 1318 4866.750000 179871.2000 36.9592
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
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 3 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 19.500000 1462.5000 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 5 9.000000 675.0000 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 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 17 31.000000 1720.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 57.000000 4275.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 109 179.500000 13462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 25.500000 2100.0000 82.3529
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 71 121.000000 9075.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 28.000000 2100.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 50 84.500000 6525.0000 77.2189
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 186 331.000000 18365.0000 55.4834
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 28.500000 2137.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 27.500000 2062.5000 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) 319 1050.500000 69773.6000 66.4194
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 6 12.000000 1658.8800 138.2400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 10.250000 512.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 17 16.250000 812.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
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 5 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 34 49.750000 2487.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 107 102.000000 5125.0000 50.2451
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 57 75.250000 3762.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 177 132.750000 6637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 13.000000 325.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 433 1512.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 372 2097.250000 104862.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 174 434.500000 21725.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 542 3046.000000 45690.0000 15.0000
INTR-T1013-INTERPRETER 2 1.500000 47.5800 31.7200
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 226 1045.000000 12540.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 62 320.000000 23203.2800 72.5103
OCCT-97530GT-OT SESSION BY LICENSED OT 31 76.000000 5468.9600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 51 229.000000 16478.8400 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 2 12.000000 863.5200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 19 56.250000 4047.7500 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 72 340.500000 25338.2200 74.4147
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 24.750000 2045.1300 82.6315
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 81 347.000000 24970.1200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 22 44.500000 3202.2200 71.9600
TRAV-TRAVS-Travel by mile 322 29767.00000 13241.5200 0.4448
Subtotal (Total Children Is Unduplicated) 790 40530.75000 375868.5000 9.2737
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Total 46448.000000 625513.3000 13.4670
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Number of Children (Unduplicated) With at Least One Service 1406
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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 5 4.000000 224.4000 0.0000
P 4369 4202.500000 217530.1600 213925.2200
D 796 730.500000 45217.7000 0.0000
S 3 2.000000 135.2300 0.0000
H 16 8.500000 350.9600 0.0000
T 4605 32450.928030 80587.8709 77821.2000
11716 9030.321970 280224.2691 0.0000
Other 20 19.250000 1242.7100 0.0000
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Total 21530 46448.000000 625513.3000 291746.4200