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
Payclass Filters:GR
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 14 15.000000 727.5000 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 100 82.000000 4100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 677.9000 67.7900
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 22.000000 1215.2200 55.2373
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.000000 732.5000 48.8333
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 25.500000 1415.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 166 195.500000 10620.4400 54.3245
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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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 191 933.750000 46687.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 45 170.000000 8500.0000 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 6 21.000000 1595.4000 75.9714
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.000000 287.8400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 23 95.500000 5855.8200 61.3175
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 359.8000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 95.000000 6523.0000 68.6632
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 8.000000 575.6800 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 1.000000 13.9600 13.9600
TRAV-TRAVS-Travel by mile 431 39252.00000 17503.3300 0.4459
Subtotal (Total Children Is Unduplicated) 1947 57858.25000 365955.1900 6.3250
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Total 58053.750000 376575.6300 6.4867
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Number of Children (Unduplicated) With at Least One Service 1974
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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 21548 57253.250000 370276.6900 370211.5100
D 288 799.250000 6242.3400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 1.250000 56.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 21838 58053.750000 376575.6300 370211.5100