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
Payclass Filters:GR
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 1532 3578.750000 133110.9000 37.1948
Subtotal (Total Children Is Unduplicated) 1630 3674.250000 136663.5000 37.1949
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 9 6.750000 337.5000 50.0000
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 4 7.500000 598.3800 79.7840
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1076.9100 76.9221
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 311.9600 77.9900
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 421.4700 76.6309
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 586.4200 78.1893
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2138.7100 57.0323
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1044.4300 56.4557
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 27.500000 2113.3300 76.8484
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 32.000000 2462.7900 76.9622
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 3 11.000000 572.2100 52.0191
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 8.000000 444.7800 55.5975
Subtotal (Total Children Is Unduplicated) 83 183.250000 12288.4100 67.0582
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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 8 35.750000 1819.5000 50.8951
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 8.750000 445.5000 50.9143
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 153.2800 76.6400
PHY-97110-PT SESSION BY LICENSED PT 2 9.000000 731.8800 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 503.7200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 513.0800 73.2971
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 139 350.750000 17476.7300 49.8267
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Total 4208.250000 166428.6400 39.5482
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Number of Children (Unduplicated) With at Least One Service 1711
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6130 4205.250000 166278.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6133 4208.250000 166428.6400 0.0000