CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2024 ending 06/30/2024 Date of Report:04/12/2025 Page: 1
List order: No List
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 986 1362.500000 50611.6000 37.1461
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 52 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1195 3304.000000 122676.2500 37.1296
Subtotal (Total Children Is Unduplicated) 1340 4704.500000 173287.8500 36.8345
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 0.000000 0.0000 0.0000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.8400 15.8400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.000000 70.4800 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 9.000000 251.2800 27.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 55.2400 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 2 2.000000 150.2600 75.1300
EXIT-EXIT-COS Exit 2 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 91.000000 6973.5000 76.6319
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 67 115.500000 8812.5000 76.2987
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 54.500000 4237.5000 77.7523
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 58 106.500000 7950.0000 74.6479
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 32.000000 2400.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 32 56.500000 4425.0000 78.3186
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 72.500000 4023.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 124 228.500000 12670.7500 55.4519
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1462.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 24.500000 1837.5000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 4.000000 205.6400 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 42.000000 2159.2200 51.4100
Subtotal (Total Children Is Unduplicated) 253 914.500000 60628.2900 66.2967
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 311.7700 77.9425
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 19.250000 962.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 24 26.750000 1371.9600 51.2882
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 10.750000 537.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 106 87.750000 4375.0000 49.8575
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 44 57.750000 2887.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 85 75.500000 3800.0000 50.3311
CONOP-CONOP-CONSULT, OT, PHONE 8 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 40 58.000000 2900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 152 90.000000 4525.0000 50.2778
CONPP-CONPP-CONSULT, PT, PHONE 19 9.750000 243.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 63 76.500000 3825.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 154 116.250000 5800.0000 49.8925
CONSP-CONSP-CONSULT, SLP, PHONE 12 6.500000 187.5000 28.8462
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 470 1416.500000 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 416 2291.000000 114525.0000 49.9891
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 190 341.500000 17062.5000 49.9634
EPIC-99601-Early Steps Professional Development Fee 586 3054.000000 45810.0000 15.0000
INTR-T1013-INTERPRETER 3 3.500000 105.9800 30.2800
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 275 1302.000000 15624.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 68 390.500000 28540.5800 73.0873
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 18 38.500000 3826.9400 99.4010
OCCT-97530TL-OT SESSION BY LICENSED OT 41 151.500000 10901.9400 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 15.500000 1115.3800 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 18 22.250000 1601.1100 71.9600
PHY-97110-PT SESSION BY LICENSED PT 35 239.140000 21586.4500 90.2670
PHY-97110GT-PT SESSION BY LICENSED PT 5 3.750000 269.8500 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 49 262.000000 19189.6000 73.2427
PHY-97110TLGT-PT SESSION BY LICENSED PT 7 6.500000 467.7400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 79 347.250000 25450.3200 73.2911
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 31 54.500000 4996.2900 91.6750
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 79 333.250000 23980.6700 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 17 27.250000 1960.9100 71.9600
TRAV-TRAVS-Travel by mile 375 31080.00000 13825.9600 0.4449
Subtotal (Total Children Is Unduplicated) 840 42033.64000 383262.9600 9.1180
-----------------------------------------------------------------------------------------------------------------------
Total 47652.640000 617179.1000 12.9516
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1436
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 7.500000 436.9200 0.0000
P 4107 3954.290000 205259.8000 199961.9000
D 858 776.150000 46833.7800 31.5700
S 6 6.200000 452.1000 0.0000
H 7 5.250000 230.0600 0.0000
T 5285 34192.630777 92706.7000 62521.5200
11407 8697.119223 270574.1600 0.0000
Other 13 13.500000 685.5800 50.0000
---------------------------------------------------------
Total 21690 47652.640000 617179.1000 262564.9900