CMS/EIP Fiscal Report Center: 03
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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 5 5.000000 242.5000 48.5000
EXIT-EXIT-COS Exit 6 5.250000 262.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 425.6200 65.4800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 617.1100 64.9589
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 250.0000 62.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 140.000000 9572.5600 68.3754
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 4.6000 4.6000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 71 128.000000 9161.2100 71.5720
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 33.500000 2418.6200 72.1976
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 47.000000 2608.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 5.000000 257.0500 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 52.3300 26.1650
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 219.0400 54.7600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 12.000000 571.9200 47.6600
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 838.9700 49.3512
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4400 51.4400
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 8.000000 411.2800 51.4100
Subtotal (Total Children Is Unduplicated) 172 439.750000 28548.7500 64.9204
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 78 84.500000 4181.2500 49.4822
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 120 126.250000 6087.5000 48.2178
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 4.000000 162.5000 40.6250
CONOF-CONOF-CONSULT, OT, FACE TO FACE 32 46.000000 2300.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 22 33.000000 1650.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 53.000000 2650.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 52 77.000000 3850.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 19 28.500000 1425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 226 1326.250000 66614.4600 50.2277
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 38 78.750000 3937.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 314 1688.000000 24984.0000 14.8009
INTR-T1013-INTERPRETER 14 66.000000 4652.5000 70.4924
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 372 1999.000000 23988.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 151.750000 10438.3400 68.7864
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 9.000000 647.6400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 47 216.000000 14558.0800 67.3985
PHY-97110GT-PT SESSION BY LICENSED PT 9 13.500000 926.4600 68.6267
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 388.750000 26204.0000 67.4058
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 4.750000 341.8100 71.9600
TRAV-TRAVS-Travel by mile 501 55349.00000 24619.2000 0.4448
Subtotal (Total Children Is Unduplicated) 691 61750.25000 224593.4100 3.6371
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Total 62190.000000 253142.1600 4.0705
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Number of Children (Unduplicated) With at Least One Service 756
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Center 03
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 9637 62105.000000 251024.0600 251024.0600
D 0 0.000000 0.0000 0.0000
S 8 23.000000 161.5600 161.5600
H 12 34.000000 440.0000 440.0000
T 2 9.000000 18.5600 18.5600
18 19.000000 1497.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9677 62190.000000 253142.1600 251644.1800