CMS/EIP Fiscal Report Center: 05
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 277.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 42.500000 3187.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 37.500000 2812.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 30.000000 2250.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 14.500000 1087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 39.000000 2164.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 34.500000 1914.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 7 8.000000 411.2800 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 379.3500 47.4188
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 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 10 10.000000 401.0300 40.1030
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 16.000000 625.8400 39.1150
Subtotal (Total Children Is Unduplicated) 101 286.500000 18250.2800 63.7008
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 7.000000 966.3900 138.0557
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 63 65.000000 3250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 27 22.000000 1100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 28 26.250000 1287.5000 49.0476
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 23 55.000000 2750.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 11 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 15.250000 762.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 19 54.000000 2700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 16.000000 800.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 6.750000 337.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 18 15.250000 762.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 9 8.500000 425.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 8.000000 200.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 7 17.500000 875.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 192 862.000000 43062.0000 49.9559
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 15 38.500000 1925.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 403 2722.000000 40782.0000 14.9824
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 233 1046.000000 12552.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 33 204.500000 13715.4200 67.0681
PHY-97110-PT SESSION BY LICENSED PT 51 230.000000 13204.4000 57.4104
PHY-97110GT-PT SESSION BY LICENSED PT 2 4.000000 287.8400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 223.750000 13619.7700 60.8705
TRAV-TRAVS-Travel by mile 504 50273.00000 22377.6300 0.4451
Subtotal (Total Children Is Unduplicated) 619 55927.00000 177911.2000 3.1811
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Total 56213.500000 196161.4800 3.4896
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Number of Children (Unduplicated) With at Least One Service 629
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Center 05
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 9108 56171.500000 195084.8900 195084.8900
D 0 0.000000 0.0000 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
12 42.000000 1076.5900 1076.5900
Other 0 0.000000 0.0000 0.0000
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Total 9120 56213.500000 196161.4800 196161.4800