CMS/EIP Fiscal Report Center: 54
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
Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 23.7600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 19.000000 1054.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 46.500000 3487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 151.000000 8391.5500 55.5732
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 90 174.500000 9733.3700 55.7786
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.000000 975.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1162.5000 80.1724
Subtotal (Total Children Is Unduplicated) 221 472.500000 28406.6100 60.1198
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 26 66.000000 3870.3100 58.6411
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 58 51.250000 2562.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 65 66.000000 3300.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 44 51.500000 2575.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 9 8.250000 412.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 58.000000 1450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 489 2690.000000 134386.0000 49.9576
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 192 349.000000 17482.0000 50.0917
EPIC-99601-Early Steps Professional Development Fee 384 1944.000000 29160.0000 15.0000
INTR-T1013-INTERPRETER 4 5.750000 178.7400 31.0852
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 273 1341.000000 16092.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 37 178.000000 12808.8800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 208.000000 14967.6800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 17.000000 1223.3200 71.9600
TRAV-TRAVS-Travel by mile 623 40672.00000 18094.2300 0.4449
Subtotal (Total Children Is Unduplicated) 692 47709.75000 258829.0400 5.4251
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Total 48182.250000 287235.6500 5.9614
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Number of Children (Unduplicated) With at Least One Service 763
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Center 54
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 7952 45607.090000 152391.8900 152157.9200
2485 2575.160000 134843.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10437 48182.250000 287235.6500 152157.9200