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: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 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 3302.000000 122601.8500 37.1296
Subtotal (Total Children Is Unduplicated) 1340 4702.500000 173213.4500 36.8343
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
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 3 5.500000 412.5000 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 5 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 73.500000 5661.0000 77.0204
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 50 86.000000 6600.0000 76.7442
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 37.000000 2925.0000 79.0541
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 30 54.500000 4050.0000 74.3119
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 31 54.500000 4275.0000 78.4404
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 57.500000 3191.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 71 128.500000 7120.7500 55.4144
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) 213 646.500000 44210.2200 68.3839
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 16.250000 812.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 23 26.250000 1346.9600 51.3128
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 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
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 33.250000 1662.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 85 75.500000 3800.0000 50.3311
CONOP-CONOP-CONSULT, OT, PHONE 6 3.000000 75.0000 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 59 60.500000 3025.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 154 116.250000 5800.0000 49.8925
CONSP-CONSP-CONSULT, SLP, PHONE 11 5.500000 162.5000 29.5455
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 159 614.500000 30700.0000 49.9593
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 97 153.500000 7662.5000 49.9186
EPIC-99601-Early Steps Professional Development Fee 401 1794.000000 26910.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 125 358.000000 4296.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 55.500000 4433.9800 79.8915
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 8 26.000000 2927.4400 112.5938
OCCT-97530TL-OT SESSION BY LICENSED OT 34 123.500000 8887.0600 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 45 218.250000 16167.4800 74.0778
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 32.500000 3413.1700 105.0206
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 65 295.250000 21246.1900 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 17 27.250000 1960.9100 71.9600
Subtotal (Total Children Is Unduplicated) 570 6264.890000 202638.5800 32.3451
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Total 11613.890000 420062.2500 36.1690
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Number of Children (Unduplicated) With at Least One Service 1385
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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 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 0 0.000000 0.0000 0.0000
9631 6851.000000 166164.0100 0.0000
Other 13 13.500000 685.5800 50.0000
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Total 14629 11613.890000 420062.2500 200043.4700