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:OTHER
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 102 157.500000 5859.0000 37.2000
Subtotal (Total Children Is Unduplicated) 102 157.500000 5859.0000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 11 21.000000 1050.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 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 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 10.000000 555.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 30.000000 2250.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 134 216.000000 16200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 48.000000 2664.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 100 155.500000 8630.2500 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 1.000000 50.0000 50.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 17.000000 873.9700 51.4100
Subtotal (Total Children Is Unduplicated) 211 540.000000 35207.7200 65.1995
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 64.000000 3100.0000 48.4375
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 18.000000 450.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 7.000000 350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 6.000000 300.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.000000 200.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 270 1320.000000 65936.0000 49.9515
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 7.750000 387.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 387 2486.000000 13623.0000 5.4799
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 20 54.000000 648.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 60 332.500000 23926.7000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 67 296.000000 19573.1200 66.1254
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 75 400.000000 28380.5000 70.9513
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 10.000000 576.0000 57.6000
TRAV-TRAVS-Travel by mile 515 31910.00000 14200.0400 0.4450
Subtotal (Total Children Is Unduplicated) 613 36925.50000 172185.6600 4.6631
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Total 37623.000000 213252.3800 5.6681
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Number of Children (Unduplicated) With at Least One Service 780
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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 8244 37090.000000 185930.9900 185930.9900
D 33 67.000000 1405.8900 0.0000
S 0 0.000000 0.0000 0.0000
H 306 466.000000 25915.5000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8583 37623.000000 213252.3800 185930.9900