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
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 419 199.500000 7412.1000 37.1534
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 13.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 321 863.000000 31852.5000 36.9090
Subtotal (Total Children Is Unduplicated) 600 1076.250000 39264.6000 36.4828
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 32.000000 1776.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 26 60.500000 3636.7300 60.1112
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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 2 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 163.250000 8162.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 6.000000 300.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 198 1185.000000 17775.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 265 1280.000000 15360.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 10.000000 719.6000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 1 8.000000 575.6800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 280 25378.00000 11290.1300 0.4449
Subtotal (Total Children Is Unduplicated) 480 28648.75000 65336.2900 2.2806
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Total 29785.500000 108237.6200 3.6339
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Number of Children (Unduplicated) With at Least One Service 799
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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 10 10.750000 516.9800 0.0000
S 1 0.500000 18.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 4122 28082.750000 56624.5900 54165.3300
2767 1691.500000 51077.4500 12.0000
Other 0 0.000000 0.0000 0.0000
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Total 6900 29785.500000 108237.6200 54177.3300