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
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
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 2 4.000000 323.9200 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 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 35.000000 2784.3000 79.5514
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 39.500000 3198.7100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.500000 689.0800 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 15.000000 871.6500 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 58 126.500000 9248.1500 73.1079
-----------------------------------------------------------------------------------------------------------------------
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 229 1207.750000 65110.5000 53.9106
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 30 82.000000 4428.0000 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 16 57.000000 4583.3500 80.4096
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 20 93.500000 7603.4200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 162.000000 13140.1900 81.1123
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 487 49692.00000 22093.4800 0.4446
Subtotal (Total Children Is Unduplicated) 664 55078.25000 184896.0800 3.3570
-----------------------------------------------------------------------------------------------------------------------
Total 55204.750000 194144.2300 3.5168
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 689
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 8076 54544.750000 190210.3800 190210.3800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 76 457.000000 1940.6300 1940.6300
T 0 0.000000 0.0000 0.0000
38 203.000000 1993.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8190 55204.750000 194144.2300 192151.0100