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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 107 88.500000 4425.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 827.9000 68.9917
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 39.500000 2467.7200 62.4739
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 91.500000 4978.2500 54.4071
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 42 75.000000 4055.5000 54.0733
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 40.500000 2998.5000 74.0370
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 23.500000 1762.5000 75.0000
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
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 26.000000 1336.6600 51.4100
Subtotal (Total Children Is Unduplicated) 290 432.500000 24637.7800 56.9660
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 160 175.250000 8812.5000 50.2853
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 82 98.250000 4912.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 45 43.000000 1118.2500 26.0058
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 155 294.250000 14712.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 143 374.250000 12712.5000 33.9679
CONIP-CONIP-CONSULT, ITDS PHONE 4 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 31 54.250000 2712.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 74 161.000000 8050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 17.500000 875.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 69 119.500000 5975.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 96 228.000000 8171.9600 35.8419
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 59 95.500000 4775.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 4.500000 137.5000 30.5556
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 632 4177.500000 208859.0000 49.9962
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 119 494.500000 24725.0000 50.0000
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 22 148.000000 10856.0000 73.3514
OCCT-97530GT-OT SESSION BY LICENSED OT 7 20.000000 1439.2000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 63 462.000000 32050.2400 69.3728
PHY-97110GT-PT SESSION BY LICENSED PT 6 15.750000 1142.7300 72.5543
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 696.500000 50022.2200 71.8194
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 57.500000 4156.4200 72.2856
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) 1962 62608.75000 629162.8000 10.0491
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Total 63041.250000 653800.5800 10.3710
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Number of Children (Unduplicated) With at Least One Service 2028
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Center 01
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 0 0.000000 0.0000 0.0000
P 26196 61969.250000 632762.9200 632637.7400
D 555 1068.750000 20859.1000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.9600 71.9600
3 2.250000 106.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 26755 63041.250000 653800.5800 632709.7000