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
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
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Screening, Eval, and Assessment,Class #02
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 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 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 18.500000 1387.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 35.500000 2812.5000 79.2254
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 19 35.000000 2625.0000 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 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 52 89.000000 4939.5000 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) 107 256.920000 17308.7200 67.3701
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 5.000000 359.8000 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 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 48 304.000000 15200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 28 57.750000 2887.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 711 6716.000000 100737.0000 14.9996
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 238 1113.000000 13356.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 33.000000 2374.6800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 215.8800 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 22 166.750000 11999.3300 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 9.000000 647.6400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 13 65.000000 4677.4000 71.9600
Subtotal (Total Children Is Unduplicated) 1052 16226.75000 272561.5200 16.7970
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Total 27087.670000 680666.4400 25.1283
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Number of Children (Unduplicated) With at Least One Service 2769
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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 1 0.250000 9.3000 0.0000
P 0 0.000000 0.0000 0.0000
D 1323 985.670000 43595.4700 0.0000
S 10 4.750000 211.4600 0.0000
H 1 1.000000 71.9600 0.0000
T 0 0.000000 0.0000 0.0000
37140 26090.250000 636564.3500 0.0000
Other 7 5.750000 213.9000 0.0000
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Total 38482 27087.670000 680666.4400 0.0000