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
Payclass Filters:GR
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 1067 4133.250000 153756.9000 37.2000
Subtotal (Total Children Is Unduplicated) 2039 9502.000000 353633.1000 37.2167
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 218 393.500000 19675.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 27.000000 1947.0000 72.1111
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1012.5000 72.3214
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 32.000000 1776.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 52.500000 2913.7500 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
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 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) 342 1052.500000 54958.5500 52.2172
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 139 239.250000 11812.5000 49.3730
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 14.000000 700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 68 79.250000 1981.2500 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 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 38 42.000000 2100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 59 209.000000 50.0000 0.2392
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 651 4167.500000 208087.0000 49.9309
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 26 60.000000 3004.0000 50.0667
EPIC-99601-Early Steps Professional Development Fee 877 6765.000000 51642.0000 7.6337
INTR-T1013-INTERPRETER 82 326.250000 16312.5000 50.0000
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 78 441.750000 31793.0100 71.9706
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 359.8000 71.9600
TRAV-TRAVS-Travel by mile 1416 140489.0000 62472.3500 0.4447
Subtotal (Total Children Is Unduplicated) 1561 155848.7500 461970.2800 2.9642
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Total 166403.250000 870561.9300 5.2316
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Number of Children (Unduplicated) With at Least One Service 2265
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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 37223 164409.000000 865244.0000 863351.7500
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 9 40.500000 183.4000 183.4000
0 0.000000 0.0000 0.0000
Other 1 2.000000 0.0000 0.0000
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Total 37420 166403.250000 870561.9300 863535.1500