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: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 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
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 11 8.750000 437.5000 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 12 20.000000 1118.8400 55.9420
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 100.500000 7689.9900 76.5173
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 33.500000 2599.2100 77.5884
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 169 288.500000 16413.9700 56.8942
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 56 99.500000 5623.9100 56.5217
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 180 321.000000 24714.8600 76.9933
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 243.000000 18661.5400 76.7965
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 34.000000 1801.5400 52.9865
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 25.000000 1379.0500 55.1620
Subtotal (Total Children Is Unduplicated) 588 1349.250000 93803.9800 69.5231
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 17.500000 875.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 47 45.750000 2287.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 22.500000 1100.0000 48.8889
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 11 13.250000 662.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.000000 100.0000 33.3333
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 18.000000 900.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 11 15.000000 750.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 10 13.000000 325.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 11.750000 587.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 20 26.500000 1325.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 10 13.750000 343.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 29.750000 1487.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 25 41.000000 2050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.500000 112.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 84 444.500000 22763.0000 51.2103
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 49.250000 2484.5000 50.4467
OCCT-97530-OT SESSION BY LICENSED OT 13 50.000000 3766.4800 75.3296
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 287.8400 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 14 59.000000 4573.2400 77.5125
PHY-97110GT-PT SESSION BY LICENSED PT 2 9.000000 703.8000 78.2000
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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 80.750000 6016.6900 74.5101
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 6.000000 441.1200 73.5200
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
Subtotal (Total Children Is Unduplicated) 222 1140.500000 66119.9100 57.9745
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Total 10917.500000 473296.6900 43.3521
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Number of Children (Unduplicated) With at Least One Service 3188
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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 0 0.000000 0.0000 0.0000
D 3 3.000000 150.0000 0.0000
S 3 1.500000 68.6000 0.0000
H 8011 6514.250000 294707.4800 253879.9300
T 0 0.000000 0.0000 0.0000
6282 4375.250000 177496.4100 0.0000
Other 54 23.500000 874.2000 0.0000
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Total 14353 10917.500000 473296.6900 253879.9300