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:EIP DEI DEIP
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 419 199.500000 7412.1000 37.1534
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 13.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 715 1875.500000 69303.6000 36.9521
Subtotal (Total Children Is Unduplicated) 815 2088.750000 76715.7000 36.7280
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 49 95.000000 7125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 56.500000 4237.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 54.000000 3825.3000 70.8389
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 7.500000 397.7000 53.0267
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 110 218.000000 12099.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 14.000000 1050.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 11 11.000000 550.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 17.000000 873.9700 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 164 531.500000 33878.0300 63.7404
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 54 49.000000 2450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 21 17.500000 875.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 7.500000 200.0000 26.6667
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 44 92.250000 4612.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 3.500000 175.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 28.750000 1437.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 14.000000 700.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 221 392.750000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 318 1618.250000 80929.0000 50.0102
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 30 157.000000 7850.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 198 1185.000000 17775.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 265 1283.000000 15396.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 119.000000 8563.2400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 8 28.500000 2050.8600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 25 158.250000 10121.1600 63.9568
PHY-97110TL-PT SESSION BY LICENSED PT 21 100.750000 7249.9700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 116.750000 6977.4100 59.7637
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 36.000000 2589.8200 71.9394
TRAV-TRAVS-Travel by mile 280 25428.00000 11312.3700 0.4449
Subtotal (Total Children Is Unduplicated) 480 30850.00000 182018.2100 5.9001
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Total 33470.250000 292611.9400 8.7424
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Number of Children (Unduplicated) With at Least One Service 911
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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 57 60.500000 2853.4000 0.0000
P 2618 2580.000000 126984.3700 127765.2700
D 135 146.500000 9749.1200 15.0000
S 23 28.500000 1262.9600 110.0000
H 10 15.000000 1109.8000 0.0000
T 4697 28663.500000 87333.3700 76533.6400
2925 1924.500000 60423.5700 49.6000
Other 44 51.750000 2895.3500 2680.2500
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Total 10509 33470.250000 292611.9400 207153.7600