CMS/EIP Fiscal Report Center: 02
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:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 14 14.000000 700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.500000 1162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 25.000000 1387.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 31.000000 2325.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 55 114.000000 7688.9100 67.4466
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 87.6700 87.6700
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 28.250000 1412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 30 31.500000 1575.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 40 42.500000 2125.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 42 34.000000 1700.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 8.000000 400.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 5.500000 275.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 21 18.250000 912.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 122 713.250000 35362.5000 49.5794
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 26 58.000000 2908.0000 50.1379
EPIC-99601-Early Steps Professional Development Fee 330 2105.000000 31607.0000 15.0152
INTR-T1013-INTERPRETER 21 81.000000 4050.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 94 428.000000 5136.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 27.250000 1834.4900 67.3207
OCCT-97530GT-OT SESSION BY LICENSED OT 1 9.000000 647.6400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 15.000000 1079.4000 71.9600
TRAV-TRAVS-Travel by mile 110 7222.000000 3213.2000 0.4449
Subtotal (Total Children Is Unduplicated) 436 10829.50000 94400.9000 8.7170
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Total 10943.500000 102089.8100 9.3288
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Number of Children (Unduplicated) With at Least One Service 440
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Center 02
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 0 0.000000 0.0000 0.0000
S 3 3.000000 -150.0000 150.0000
H 0 0.000000 0.0000 0.0000
T 3963 10940.500000 102239.8100 97318.7200
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3966 10943.500000 102089.8100 97468.7200