CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 4 4.000000 187.5000 46.8750
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 205.4100 58.6886
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 149.8000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 96.500000 7351.4900 76.1812
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 65 121.500000 9617.3500 79.1551
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 268.2000 44.7000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 29.500000 1767.6400 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 290.5500 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 18.000000 998.0200 55.4456
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 134 312.500000 22611.6500 72.3573
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 90.750000 4358.3000 48.0253
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 88 86.750000 3939.5400 45.4126
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.500000 87.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 7.000000 350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 48.000000 2400.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 20 31.000000 1550.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 34.000000 1700.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 48 67.500000 3375.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 14 22.000000 1100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 232 1215.750000 65542.5000 53.9112
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 83.000000 4482.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 305 1611.000000 24165.0000 15.0000
INTR-T1013-INTERPRETER 11 41.500000 2940.0000 70.8434
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 336 1723.000000 20652.0000 11.9861
OCCT-97530-OT SESSION BY LICENSED OT 31 107.500000 7773.9800 72.3161
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 42 210.750000 16146.7600 76.6157
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 322.750000 24720.1700 76.5923
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 487 49692.00000 22093.4800 0.4446
Subtotal (Total Children Is Unduplicated) 668 55416.75000 208777.3500 3.7674
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Total 55729.250000 231389.0000 4.1520
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Number of Children (Unduplicated) With at Least One Service 720
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Center 03
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 8405 54942.250000 218154.2100 218154.2100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 105 486.000000 4160.5300 4160.5300
T 0 0.000000 0.0000 0.0000
126 301.000000 9074.2600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8636 55729.250000 231389.0000 222314.7400