CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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 1 0.250000 9.3000 37.2000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 112.000000 8100.0000 72.3214
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 55.000000 3975.0000 72.2727
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 46.000000 2553.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 280.5000 70.1250
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 9 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 8.000000 359.8700 44.9838
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 18.000000 668.3300 37.1294
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 21.000000 1079.6100 51.4100
Subtotal (Total Children Is Unduplicated) 115 307.000000 19826.1800 64.5804
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 8.500000 425.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 33 36.000000 1800.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 11.000000 275.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 80.750000 4037.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 21.000000 1050.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 89.250000 4462.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 8.000000 400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 210 970.000000 48520.0000 50.0206
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 200 1085.000000 16275.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 189 867.000000 10404.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 112.000000 7061.4400 63.0486
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 14 59.000000 4245.6400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 21 58.000000 4159.2800 71.7117
PHY-97110HM-PT SESSION BY PT ASST 12 64.000000 3683.8400 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 14 41.000000 2950.3600 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 9 44.000000 2532.6400 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 268.750000 17597.8400 65.4803
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 188.000000 13528.4800 71.9600
TRAV-TRAVS-Travel by mile 173 9906.000000 4406.7200 0.4449
Subtotal (Total Children Is Unduplicated) 386 13922.50000 148084.1600 10.6363
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Total 14229.750000 167919.6400 11.8006
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Number of Children (Unduplicated) With at Least One Service 444
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Center 52
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3909 12873.000000 93975.0600 93975.0600
1188 1356.750000 73944.5800 162.0000
Other 0 0.000000 0.0000 0.0000
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Total 5097 14229.750000 167919.6400 94137.0600