CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 Page: 1
List order: No List
Payclass Filters:GR
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 2476 6223.750000 231291.9000 37.1628
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 115 90.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1529 4289.500000 159504.3000 37.1848
Subtotal (Total Children Is Unduplicated) 2704 10604.00000 390796.2000 36.8537
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 4.000000 194.0000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 2 2.000000 31.6800 15.8400
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 5.000000 44.0500 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 10.000000 280.2000 28.0200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 27.6200 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
EXIT-EXIT-COS Exit 8 10.000000 500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.000000 1650.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 51.500000 4012.5000 77.9126
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.500000 1087.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 59.000000 4425.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 23.500000 1762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.000000 610.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 102 181.000000 10045.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.8200 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 0.420000 21.4000 50.9524
Subtotal (Total Children Is Unduplicated) 179 450.420000 28332.3500 62.9021
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 14.000000 1450.4700 103.6050
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 43.000000 2150.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 68 69.250000 3496.9600 50.4976
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 33.500000 1675.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 365 382.750000 19175.0000 50.0980
CONIP-CONIP-CONSULT, ITDS PHONE 8 7.750000 193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 126 231.500000 11537.5000 49.8380
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 267 347.000000 17350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 94 228.000000 11400.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 461 344.750000 17250.0000 50.0363
CONPP-CONPP-CONSULT, PT, PHONE 50 25.000000 631.2500 25.2500
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 166 260.000000 13000.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 474 484.250000 24200.0000 49.9742
CONSP-CONSP-CONSULT, SLP, PHONE 50 40.750000 1043.7500 25.6135
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 817 5351.000000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 175 1583.250000 78862.5000 49.8105
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 83 231.250000 11562.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1039 11716.00000 175737.0000 14.9997
INTR-T1013-INTERPRETER 8 11.000000 449.7100 40.8827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 476 3261.000000 39132.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 141.543090 10185.4400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 4.500000 323.8200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 12 52.500000 3777.9000 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 2.500000 179.9000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 5 16.000000 1151.3600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 220.750000 15885.1700 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 10.000000 719.6000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 13 65.000000 4677.4000 71.9600
TRAV-TRAVS-Travel by mile 648 102352.0000 45531.2200 0.4448
Subtotal (Total Children Is Unduplicated) 1334 127540.7931 513173.1200 4.0236
-----------------------------------------------------------------------------------------------------------------------
Total 138595.213090 932301.6700 6.7268
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2798
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.3000 0.0000
P 0 0.000000 0.0000 0.0000
D 1324 986.670000 43667.4300 0.0000
S 10 4.750000 211.4600 0.0000
H 1 1.000000 71.9600 0.0000
T 16178 111506.543090 251563.2700 222660.8400
37140 26090.250000 636564.3500 0.0000
Other 7 5.750000 213.9000 0.0000
---------------------------------------------------------
Total 54661 138595.213090 932301.6700 222660.8400