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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1067 1483.500000 55112.8000 37.1505
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 60 42.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1297 3774.750000 140141.6500 37.1261
Subtotal (Total Children Is Unduplicated) 1446 5300.750000 195254.4500 36.8353
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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
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 6 12.000000 900.0000 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 3 5.000000 375.0000 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 9 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 112.500000 8586.0000 76.3200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 82 139.500000 10575.0000 75.8065
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 67.500000 5212.5000 77.2222
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 84 150.500000 11250.0000 74.7508
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 42.000000 3150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 51 85.500000 6600.0000 77.1930
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 90.500000 5061.7500 55.9309
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 167 299.000000 16583.5000 55.4632
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 25.500000 1912.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 33.500000 2512.5000 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) 330 1168.500000 77846.7900 66.6211
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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 486 1440.250000 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 602 3091.000000 46365.0000 15.0000
INTR-T1013-INTERPRETER 3 3.500000 105.9800 30.2800
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 291 1320.000000 15840.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 69 401.500000 29332.1400 73.0564
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 380 31518.00000 14020.8400 0.4449
Subtotal (Total Children Is Unduplicated) 862 42561.39000 385020.4000 9.0462
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Total 49030.640000 658121.6400 13.4227
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Number of Children (Unduplicated) With at Least One Service 1543
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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 10 11.500000 585.7200 0.0000
P 4464 4337.260000 222845.6800 217435.2800
D 891 825.400000 50086.5300 31.5700
S 8 9.230000 679.1700 0.0000
H 7 5.250000 230.0600 0.0000
T 5324 34659.630777 93827.0800 63348.1900
11984 9168.869223 289181.8200 0.0000
Other 13 13.500000 685.5800 50.0000
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Total 22701 49030.640000 658121.6400 280865.0400