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
Payclass Filters:GR
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
Subtotal (Total Children Is Unduplicated) 3 10.000000 672.0000 67.2000
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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 10 47.000000 2350.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 200 1084.000000 16260.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 189 866.000000 10392.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 115.1200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 13.000000 935.4800 71.9600
TRAV-TRAVS-Travel by mile 166 9777.000000 4349.3500 0.4449
Subtotal (Total Children Is Unduplicated) 380 12046.75000 46998.9100 3.9014
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Total 12057.000000 47680.2100 3.9546
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Number of Children (Unduplicated) With at Least One Service 382
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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 3149 12056.750000 47670.9100 47670.9100
1 0.250000 9.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3150 12057.000000 47680.2100 47670.9100