CMS/EIP Fiscal Report Center: 09
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 71 111.000000 4129.2000 37.2000
Subtotal (Total Children Is Unduplicated) 71 111.000000 4129.2000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 65 128.000000 6400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 16.500000 1162.5000 70.4545
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 111.0000 55.5000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 65 131.500000 9862.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 26.000000 1950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 58 114.000000 8550.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 123 218.500000 16348.5000 74.8215
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 56.000000 4161.0000 74.3036
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1462.5000 73.1250
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 125.500000 7004.2500 55.8108
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 125 217.000000 12043.5000 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 11 52.000000 2600.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 38 265.000000 13250.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 35 430.000000 20868.7700 48.5320
Subtotal (Total Children Is Unduplicated) 509 1862.500000 109687.1600 58.8924
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2177.7400 1088.8700
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 155 284.250000 13962.5000 49.1205
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 4 7.000000 350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 73 88.250000 2206.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 27 29.000000 1450.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 25.000000 1250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 19.000000 950.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 38.000000 1900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1360 11017.50000 551346.9600 50.0428
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 65 122.250000 6074.5000 49.6892
EPIC-99601-Early Steps Professional Development Fee 1004 9264.000000 65304.0000 7.0492
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 347 2437.000000 28992.0000 11.8966
OCCT-97530-OT SESSION BY LICENSED OT 143 998.500000 71638.3900 71.7460
OCCT-97530GT-OT SESSION BY LICENSED OT 4 5.000000 359.8000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 17 116.000000 6681.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 192 1551.750000 109572.5200 70.6122
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 303 2468.500000 176397.9400 71.4596
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 8.000000 575.6800 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 27.000000 1555.2000 57.6000
TRAV-TRAVS-Travel by mile 1540 172047.0000 76515.7400 0.4447
Subtotal (Total Children Is Unduplicated) 1659 200561.0000 1119507.7800 5.5819
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Total 202534.500000 1233324.1400 6.0895
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Number of Children (Unduplicated) With at Least One Service 1796
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Center 09
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 37426 193402.000000 843855.1700 843927.1300
D 243 2041.750000 7709.8600 0.0000
S 0 0.000000 0.0000 0.0000
H 213 329.500000 18342.4500 0.0000
T 15 43.500000 588.4600 588.4600
6514 6666.250000 359345.9500 357168.2100
Other 26 51.500000 3482.2500 0.0000
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Total 44437 202534.500000 1233324.1400 1201683.8000