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
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 2476 6223.750000 231291.9000 37.1628
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 115 90.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2593 11216.00000 416816.6500 37.1627
Subtotal (Total Children Is Unduplicated) 2828 17530.50000 648108.5500 36.9703
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 4.000000 194.0000 48.5000
EXIT-EXIT-COS Exit 4 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 25.500000 1912.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 21 37.000000 2775.0000 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 9 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 22.000000 1650.0000 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 28 49.500000 2747.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 74 142.500000 10836.0000 76.0421
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 218 382.500000 28987.5000 75.7843
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 58.000000 4687.5000 80.8190
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 161 292.000000 21862.5000 74.8716
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 64.500000 4837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 153 262.500000 20062.5000 76.4286
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 90.500000 5022.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 387 687.000000 38184.2500 55.5811
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 60.000000 4500.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 105.000000 7873.5000 74.9857
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.8200 51.4100
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 11.580000 595.5100 51.4257
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 8 80.420000 4134.2000 51.4076
Subtotal (Total Children Is Unduplicated) 796 2413.500000 163612.2300 67.7904
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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 5 9.000000 647.6400 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 44 33.500000 1675.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 59 60.500000 3059.4600 50.5696
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 35 28.500000 1425.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 365 382.750000 19175.0000 50.0980
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 78 138.500000 6887.5000 49.7292
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 265 341.000000 17050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 6 3.000000 75.0000 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 152 220.750000 11037.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 474 480.000000 23987.5000 49.9740
CONSP-CONSP-CONSULT, SLP, PHONE 47 37.750000 968.7500 25.6623
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 817 5352.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 312 2366.000000 118300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 220 546.500000 27299.7000 49.9537
EPIC-99601-Early Steps Professional Development Fee 711 6717.000000 100752.0000 14.9996
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 238 1113.000000 13356.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 252.500000 19666.5800 77.8874
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 17 76.000000 6525.4400 85.8611
OCCT-97530TL-OT SESSION BY LICENSED OT 75 563.500000 40549.4600 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 15.500000 1115.3800 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 4 17.000000 1223.3200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 44 152.000000 10901.9400 71.7233
PHY-97110-PT SESSION BY LICENSED PT 57 698.600000 70485.8100 100.8958
PHY-97110GT-PT SESSION BY LICENSED PT 23 28.250000 2536.9900 89.8050
PHY-97110TL-PT SESSION BY LICENSED PT 83 1081.040000 78331.4200 72.4593
PHY-97110TLGT-PT SESSION BY LICENSED PT 27 40.750000 2932.3700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 840.170000 62713.1800 74.6434
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 44 111.270000 9345.9600 83.9935
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 124 1110.130000 79883.7500 71.9589
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 64 195.230000 14048.3700 71.9580
Subtotal (Total Children Is Unduplicated) 1082 23621.94000 775782.8900 32.8416
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Total 43565.940000 1587503.6700 36.4391
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Number of Children (Unduplicated) With at Least One Service 2854
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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 9 8.250000 464.8200 0.0000
P 15218 14370.140000 764398.2700 743340.9300
D 3053 2760.720000 167194.2700 31.5700
S 16 10.950000 663.5600 0.0000
H 26 17.750000 729.8200 0.0000
T 0 0.000000 0.0000 0.0000
37384 26330.500000 649571.9700 0.0000
Other 78 67.630000 4480.9600 50.0000
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Total 55784 43565.940000 1587503.6700 743422.5000