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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1856 5368.750000 199876.2000 37.2296
TCM-T1017TL-TARGETED CASE MANAGEMENT 2031 7581.500000 282031.8000 37.2000
Subtotal (Total Children Is Unduplicated) 2170 12950.25000 481908.0000 37.2123
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 229 414.500000 20725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 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 18 32.500000 2362.5000 72.6923
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 711.0000 71.1000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 13 26.000000 1443.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 38.000000 2109.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 167 310.500000 23248.5000 74.8744
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 65 117.000000 8775.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 111 215.000000 16125.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 240 429.500000 32059.5000 74.6438
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 113.000000 8436.0000 74.6549
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 39.000000 2887.5000 74.0385
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 280 520.500000 29034.0000 55.7810
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 288 510.500000 28371.7500 55.5764
NUTR-97802-NUTRITIONAL EVAL, INITIAL 11 53.000000 2650.0000 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-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
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 5 5.000000 263.7500 52.7500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 35 430.000000 20868.7700 48.5320
Subtotal (Total Children Is Unduplicated) 937 3578.500000 216796.8700 60.5832
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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 162 303.250000 14912.5000 49.1756
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 14.000000 700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 80 97.250000 2431.2500 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 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 46.000000 2300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 59 210.250000 50.0000 0.2378
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1395 11191.00000 560082.9600 50.0476
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 69 132.250000 6578.5000 49.7429
EPIC-99601-Early Steps Professional Development Fee 1004 9264.000000 65304.0000 7.0492
INTR-T1013-INTERPRETER 82 326.250000 16312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 347 2437.000000 28992.0000 11.8966
OCCT-97530-OT SESSION BY LICENSED OT 146 1003.500000 71998.1900 71.7471
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 10 16.000000 1151.3600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 17 116.000000 6681.6000 57.6000
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 3.000000 234.6000 78.2000
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 315 2544.750000 181884.8900 71.4746
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 11.000000 791.5600 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 27.000000 1555.2000 57.6000
TRAV-TRAVS-Travel by mile 1548 172463.0000 76700.8600 0.4447
Subtotal (Total Children Is Unduplicated) 1729 201849.2500 1155031.8300 5.7223
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Total 218378.000000 1853736.7000 8.4887
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Number of Children (Unduplicated) With at Least One Service 2356
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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 48608 204833.250000 1272213.3800 1260847.0900
D 243 2041.750000 7709.8600 0.0000
S 0 0.000000 0.0000 0.0000
H 4137 4607.750000 201609.6500 175434.8300
T 20 48.000000 755.8600 755.8600
6565 6763.250000 365921.9500 363744.2100
Other 43 84.000000 5526.0000 0.0000
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Total 59616 218378.000000 1853736.7000 1800781.9900