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
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 231 109.250000 4064.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1622 3898.500000 144996.3000 37.1928
Subtotal (Total Children Is Unduplicated) 1738 4007.750000 149060.4000 37.1930
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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 109 88.750000 4437.5000 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 13 23.500000 1732.2600 73.7132
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 29.500000 1728.8200 58.6041
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1226.9100 76.6819
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 4 7.500000 571.4700 76.1960
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 736.4200 77.5179
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 65.500000 3599.3400 54.9518
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 25 48.000000 2692.7300 56.0985
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 54.000000 4112.7900 76.1628
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 40.000000 3080.7300 77.0183
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-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
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 12.000000 623.6200 51.9683
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 8.000000 444.7800 55.5975
Subtotal (Total Children Is Unduplicated) 234 429.750000 26407.0100 61.4474
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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 130 145.000000 7250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 46 44.000000 1143.2500 25.9830
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 168 317.750000 15862.5000 49.9213
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 120 258.750000 9709.4600 37.5245
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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 199 969.500000 48507.0000 50.0330
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 48 178.750000 8945.5000 50.0448
EPIC-99601-Early Steps Professional Development Fee 228 1591.000000 23865.0000 15.0000
INTR-T1013-INTERPRETER 177 383.750000 19090.0500 49.7461
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1642 13680.00000 164160.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 23.000000 1748.6800 76.0296
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.000000 287.8400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 25 104.500000 6587.7000 63.0402
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 359.8000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 102.000000 7026.7200 68.8894
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 9.000000 647.6400 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
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 1.000000 13.9600 13.9600
TRAV-TRAVS-Travel by mile 448 39712.00000 17704.7400 0.4458
Subtotal (Total Children Is Unduplicated) 2051 58724.00000 385935.7300 6.5720
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Total 63161.500000 561403.1400 8.8884
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Number of Children (Unduplicated) With at Least One Service 3027
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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 21629 57776.250000 374249.0200 374183.8400
D 292 816.250000 6398.1700 0.0000
S 1 0.750000 27.9000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6564 4568.250000 180728.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 28486 63161.500000 561403.1400 374183.8400