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
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 54 107.000000 5350.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 561.0000 70.1250
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 562.5000 70.3125
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 29.500000 1637.2500 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 9 49.000000 2450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 37 261.000000 13050.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 17 167.000000 8021.9800 48.0358
Subtotal (Total Children Is Unduplicated) 153 668.000000 34194.3900 51.1892
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 132 220.250000 10862.5000 49.3190
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 4 7.000000 350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 61 70.250000 1756.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 26.000000 1300.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 18.000000 900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 34.000000 1700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 630 4073.000000 203362.0000 49.9293
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 58.000000 2900.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 877 6765.000000 51642.0000 7.6337
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 347 2383.000000 28344.0000 11.8943
OCCT-97530-OT SESSION BY LICENSED OT 49 228.500000 16414.1400 71.8343
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 12.000000 691.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 58 322.250000 22987.6100 71.3347
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 75 435.750000 31361.2500 71.9707
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 1408 140073.0000 62287.2300 0.4447
Subtotal (Total Children Is Unduplicated) 1481 154748.0000 438017.9800 2.8305
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Total 155416.000000 472212.3700 3.0384
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Number of Children (Unduplicated) With at Least One Service 1519
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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 26320 153428.250000 467061.8400 467061.8400
D 187 1951.750000 5134.5300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 36.000000 16.0000 16.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 26511 155416.000000 472212.3700 467077.8400