CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 204 95.500000 3552.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3141 8332.250000 309820.2000 37.1833
Subtotal (Total Children Is Unduplicated) 3160 8427.750000 313372.8000 37.1834
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 16.000000 776.0000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
EXIT-EXIT-COS Exit 118 97.250000 4862.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 13 22.000000 1229.8400 55.9018
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 62 112.500000 8517.8900 75.7146
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 40 73.000000 5066.9300 69.4100
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 38.500000 2941.3200 76.3979
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 25 44.000000 3377.7400 76.7668
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 41.000000 3125.8300 76.2398
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 38.000000 2939.7000 77.3605
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 219 380.000000 21392.2200 56.2953
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 96 174.500000 9679.4100 55.4694
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 200 361.500000 27713.3600 76.6621
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 141 266.500000 20424.0400 76.6380
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 219.0400 54.7600
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 12 60.000000 3138.2000 52.3033
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 25.000000 1379.0500 55.1620
Subtotal (Total Children Is Unduplicated) 735 1781.750000 118441.7600 66.4750
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 176 192.750000 9687.5000 50.2594
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 129 144.000000 7200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 46 44.000000 1143.2500 25.9830
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 167 316.750000 15812.5000 49.9211
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 154 387.500000 13375.0000 34.5161
CONIP-CONIP-CONSULT, ITDS PHONE 7 6.500000 187.5000 28.8462
CONOF-CONOF-CONSULT, OT, FACE TO FACE 43 72.250000 3612.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 85 176.000000 8800.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 13 14.500000 362.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 29.250000 1462.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 89 146.000000 7300.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 10 13.750000 343.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 119 257.750000 9659.4600 37.4761
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 84 136.500000 6825.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 9.000000 250.0000 27.7778
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 716 4622.000000 231622.0000 50.1129
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 143 543.750000 27209.5000 50.0405
EPIC-99601-Early Steps Professional Development Fee 228 1591.000000 23865.0000 15.0000
INTR-T1013-INTERPRETER 155 344.750000 17093.6500 49.5827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1641 13667.00000 164004.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 35 198.000000 14622.4800 73.8509
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 9 24.000000 1727.0400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 11 55.000000 4107.5600 74.6829
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 11.000000 819.6400 74.5127
PHY-97110-PT SESSION BY LICENSED PT 77 521.000000 36623.4800 70.2946
PHY-97110GT-PT SESSION BY LICENSED PT 8 24.750000 1846.5300 74.6073
PHY-97110TL-PT SESSION BY LICENSED PT 12 54.000000 4145.5800 76.7700
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 11.000000 829.0000 75.3636
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 137 777.250000 56038.9100 72.0990
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 63.500000 4597.5400 72.4022
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 9 26.750000 1943.6500 72.6598
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 234.6000 78.2000
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 5.000000 69.8000 13.9600
TRAV-TRAVS-Travel by mile 431 39252.00000 17503.3300 0.4459
Subtotal (Total Children Is Unduplicated) 2094 63749.25000 695282.7100 10.9065
-----------------------------------------------------------------------------------------------------------------------
Total 73958.750000 1127097.2700 15.2395
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3433
-----------------------------------------------------------------------------------------------------------------------
Center 01
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 26196 61969.250000 632762.9200 632637.7400
D 558 1071.750000 21009.1000 0.0000
S 3 1.500000 68.6000 0.0000
H 8011 6514.250000 294707.4800 253879.9300
T 1 1.000000 71.9600 71.9600
6285 4377.500000 177603.0100 0.0000
Other 54 23.500000 874.2000 0.0000
---------------------------------------------------------
Total 41108 73958.750000 1127097.2700 886589.6300