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
Payclass Filters:GR
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
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 12 23.500000 1762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 43.000000 2386.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 31.000000 1738.1800 56.0703
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 58 122.500000 7684.1800 62.7280
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 25 65.000000 2952.9100 45.4294
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 96 435.500000 21779.0000 50.0092
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 41 70.750000 3537.5000 50.0000
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 12 56.000000 4029.7600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.000000 0.0000 0.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 14.000000 1007.4400 71.9600
TRAV-TRAVS-Travel by mile 622 40662.00000 18089.7800 0.4449
Subtotal (Total Children Is Unduplicated) 663 44772.00000 105727.1300 2.3615
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Total 44894.500000 113411.3100 2.5262
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Number of Children (Unduplicated) With at Least One Service 678
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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 7290 44903.500000 113426.8700 113192.9000
2 -9.000000 -15.5600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7292 44894.500000 113411.3100 113192.9000