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
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 298 216.750000 8063.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 54.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1286 2977.250000 110623.5000 37.1563
Subtotal (Total Children Is Unduplicated) 1355 3248.000000 118686.6000 36.5414
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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 5 10.000000 809.8000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 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 9 15.000000 898.8000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 79 145.500000 11256.6500 77.3653
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 102 191.500000 15157.9100 79.1536
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 540.9200 54.0920
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 113 222.000000 13302.2400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.000000 359.5200 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
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
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
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) 263 659.000000 45904.4600 69.6578
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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 89 87.250000 3964.5400 45.4389
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 234 1217.500000 65637.0000 53.9113
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 15 49.500000 3535.0000 71.4141
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 338 1734.000000 20784.0000 11.9862
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 79 323.750000 24801.4900 76.6069
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 488 49859.00000 22167.7700 0.4446
Subtotal (Total Children Is Unduplicated) 677 55606.00000 209779.4600 3.7726
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Total 59513.000000 374370.5200 6.2906
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Number of Children (Unduplicated) With at Least One Service 1495
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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 8493 55242.250000 227773.3800 227773.3800
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
5230 3784.750000 142436.6100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13828 59513.000000 374370.5200 231933.9100