CMS/EIP Fiscal Report Center: 04
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 10 6.250000 232.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 129 170.000000 6324.0000 37.2000
Subtotal (Total Children Is Unduplicated) 131 176.250000 6556.5000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 24 24.000000 1267.3400 52.8058
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 17 17.000000 844.0700 49.6512
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 4 4.000000 205.6400 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 26 26.000000 1350.0600 51.9254
SPCH-92521TL-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 81 90.000000 4657.3000 51.7478
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 57.000000 2850.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 60 1979.000000 51109.0000 25.8257
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1145 11435.00000 572470.0000 50.0630
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 70.500000 3589.0000 50.9078
EPIC-99601-Early Steps Professional Development Fee 937 9267.000000 139005.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 290 2648.000000 31776.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 62 329.500000 23638.5100 71.7405
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 24 155.500000 9046.0200 58.1738
PHY-97110-PT SESSION BY LICENSED PT 54 223.500000 16607.2200 74.3052
PHY-97110HM-PT SESSION BY PT ASST 32 176.000000 10228.8400 58.1184
PHY-97110TL-PT SESSION BY LICENSED PT 1 14.000000 1091.6800 77.9771
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 248.000000 18403.0000 74.2056
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 1291 26614.00000 880430.1500 33.0815
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Total 26880.250000 891643.9500 33.1710
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Number of Children (Unduplicated) With at Least One Service 1335
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Center 04
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 14 12.250000 455.7000 0.0000
P 16057 15594.750000 364878.3600 341427.9600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8990 8928.500000 452419.0900 60.0000
T 0 0.000000 0.0000 0.0000
936 2138.750000 59936.6800 0.0000
Other 290 206.000000 13954.1200 -338.0000
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Total 26287 26880.250000 891643.9500 341149.9600