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:EIP DEI DEIP
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 1702 5038.250000 187581.6000 37.2315
TCM-T1017TL-TARGETED CASE MANAGEMENT 1818 6863.500000 255322.2000 37.2000
Subtotal (Total Children Is Unduplicated) 1956 11901.75000 442903.8000 37.2133
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 164 286.500000 14325.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
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 7 14.000000 777.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 59 104.000000 7761.0000 74.6250
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 32 55.500000 4162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 47.500000 3562.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 30 57.500000 4312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 25.500000 1912.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 139 266.000000 14792.2500 55.6100
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 68 130.000000 7254.0000 55.8000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.000000 50.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
Subtotal (Total Children Is Unduplicated) 487 1025.500000 61383.7100 59.8573
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 19.000000 950.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 6 7.000000 350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 9.000000 225.0000 25.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 57 207.250000 50.0000 0.2413
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 173.500000 8736.0000 50.3516
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 10.000000 504.0000 50.4000
INTR-T1013-INTERPRETER 76 308.500000 15425.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 6 7.000000 503.7200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 11.000000 791.5600 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 3.000000 234.6000 78.2000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 76.250000 5486.9500 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 169 851.500000 34451.4300 40.4597
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Total 13778.750000 538738.9400 39.0993
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Number of Children (Unduplicated) With at Least One Service 1990
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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 10457 10083.250000 385157.3400 376459.5900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3522 3689.000000 153303.2000 153062.4800
T 5 4.500000 167.4000 167.4000
0 0.000000 0.0000 0.0000
Other 1 2.000000 111.0000 0.0000
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Total 13985 13778.750000 538738.9400 529689.4700