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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 2.000000 74.4000 37.2000
Subtotal (Total Children Is Unduplicated) 1 2.000000 74.4000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
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
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 17.500000 1312.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 29.500000 2212.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 29 52.000000 3900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 56 100.000000 5550.0000 55.5000
Subtotal (Total Children Is Unduplicated) 116 268.000000 16418.0700 61.2615
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 311.7700 77.9425
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.000000 150.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.500000 25.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 24.500000 1225.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 16.000000 800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 258 1676.500000 83825.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 93 188.000000 9400.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 223 1260.000000 18900.0000 15.0000
INTR-T1013-INTERPRETER 3 3.500000 105.9800 30.2800
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 161 944.000000 11328.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 53 335.000000 24106.6000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 10 12.500000 899.5000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 7 28.000000 2014.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 129.000000 9282.8400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 18 22.000000 1583.1200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 14 38.000000 2734.4800 71.9600
TRAV-TRAVS-Travel by mile 375 31080.00000 13825.9600 0.4449
Subtotal (Total Children Is Unduplicated) 411 35768.75000 180624.3800 5.0498
-----------------------------------------------------------------------------------------------------------------------
Total 36038.750000 197116.8500 5.4696
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 458
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5285 34192.630777 92706.7000 62521.5200
1776 1846.119223 104410.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7061 36038.750000 197116.8500 62521.5200