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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 717 493.250000 18348.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 124 88.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1673 5911.750000 219842.5000 37.1874
Subtotal (Total Children Is Unduplicated) 1711 6493.250000 238191.4000 36.6829
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 18.000000 873.0000 48.5000
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 461.9600 76.9933
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
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 10 20.000000 1500.0000 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 25 55.000000 3061.3400 55.6607
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 48.500000 3637.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 37 72.500000 5437.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 66.000000 4950.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 102 192.500000 14449.4600 75.0621
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 31.500000 2362.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 62 123.000000 9236.9600 75.0972
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 196.000000 10897.8900 55.6015
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 197 381.000000 21200.7500 55.6450
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 75 145.000000 10875.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 78.000000 5909.9200 75.7682
Subtotal (Total Children Is Unduplicated) 406 1486.000000 98409.3300 66.2243
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 127.2300 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 34 87.000000 5381.4700 61.8560
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 92 88.000000 4400.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 179 183.750000 9187.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 54 61.250000 3062.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 187 91.250000 4562.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 84 106.500000 5325.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 297 152.250000 7612.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 38 41.500000 2040.0000 49.1566
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 116 43.250000 2162.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 54 65.000000 3250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 190 86.250000 4312.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 583 1765.500000 50.0000 0.0283
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 58.000000 1450.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 601 3169.000000 158456.0000 50.0019
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 248 503.000000 25226.0000 50.1511
EPIC-99601-Early Steps Professional Development Fee 733 3366.000000 50487.0000 14.9991
INTR-T1013-INTERPRETER 4 5.750000 178.7400 31.0852
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 442 2100.000000 25200.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 65 246.260000 19675.8600 79.8987
OCCT-97530GO-OT SESSION BY LICENSED OT 9 11.000000 800.9200 72.8109
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 17 28.750000 2156.8900 75.0223
OCCT-97530HM-OT SESSION BY OT ASST 4 12.000000 691.2000 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 115.2000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 66 227.750000 16388.8900 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 79 216.740000 15634.6600 72.1356
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 18 20.000000 1439.2000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 10 14.000000 1007.4400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 62 298.000000 21444.0800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 8 9.750000 701.6100 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 42 197.750000 14230.0900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 11 16.000000 1151.3600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 426.000000 33592.0400 78.8546
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 30 44.250000 3381.5800 76.4199
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 27 102.000000 7339.9200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 11 25.500000 1834.9800 71.9600
TRAV-TRAVS-Travel by mile 644 41007.00000 18243.2700 0.4449
Subtotal (Total Children Is Unduplicated) 1145 54887.00000 472710.4300 8.6124
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Total 62866.250000 809311.1600 12.8735
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Number of Children (Unduplicated) With at Least One Service 1788
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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 32 30.250000 1681.4600 0.0000
P 5454 5184.430000 250566.5100 246338.3800
D 553 529.250000 32203.1700 150.0000
S 31 41.500000 667.8400 0.0000
H 16 16.220000 1182.3000 0.0000
T 8028 46027.590000 156888.6800 156654.7100
12930 10977.160000 362816.3900 0.0000
Other 76 59.850000 3304.8100 295.8000
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Total 27120 62866.250000 809311.1600 403438.8900