CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 611 414.500000 15410.1000 37.1776
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 79 61.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1483 4424.000000 164349.6000 37.1495
Subtotal (Total Children Is Unduplicated) 1518 4900.250000 179759.7000 36.6838
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
AACIS-92597TLGT-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 8.000000 388.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 32.3000 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 31.6800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 127.2400 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 18.000000 1457.6400 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 12.000000 971.7600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1198.4000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 20.000000 1198.4000 59.9200
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 54.000000 4349.0000 80.5370
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 42.500000 3441.6500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 65.000000 5130.2700 78.9272
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 68 129.500000 10929.5600 84.3981
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 20.500000 1660.0900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 32 64.000000 5182.7200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 80 151.500000 9077.8800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 102 203.500000 12269.1200 60.2905
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 74.000000 5956.6400 80.4951
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3563.1200 80.9800
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 261 953.500000 68303.5100 71.6345
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 143.8200 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 143.8200 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 29 50.000000 4748.1400 94.9628
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 72.250000 3589.5000 49.6817
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 192 190.500000 9537.5000 50.0656
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 44 45.000000 2237.5000 49.7222
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 183 87.000000 4387.5000 50.4310
CONOF-CONOF-CONSULT, OT, FACE TO FACE 44 39.750000 2043.8200 51.4169
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 277 128.500000 6431.3200 50.0492
CONPF-CONPF-CONSULT, PT, FACE TO FACE 39 38.000000 1900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 114 38.750000 1950.0000 50.3226
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 65 71.250000 3562.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 190 79.750000 3990.6600 50.0396
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 524 1622.500000 268.9600 0.1658
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 41.000000 1134.0000 27.6585
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 609 2867.500000 154920.0000 54.0262
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 247 546.000000 29484.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 704 3166.000000 47724.9600 15.0742
INTR-T1013-INTERPRETER 2 5.500000 217.1600 39.4836
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 435 1859.000000 22320.0000 12.0065
OCCT-97530-OT SESSION BY LICENSED OT 42 361.680000 15306.9400 42.3218
OCCT-97530GO-OT SESSION BY LICENSED OT 29 100.000000 8053.9000 80.5390
OCCT-97530GOGT-OT SESSION BY LICENSED OT 11 32.250000 2622.5700 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 7 11.500000 935.1800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 10 42.000000 2712.4800 64.5829
OCCT-97530HMGT-OT SESSION BY OT ASST 2 4.000000 260.4800 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 3 6.750000 569.2400 84.3319
OCCT-97530TLGO-OT SESSION BY LICENSED OT 79 352.250000 28616.8100 81.2401
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 13 17.750000 1443.4300 81.3200
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 6 8.000000 520.9600 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 16 61.000000 3972.3200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 60 239.500000 19489.7400 81.3768
PHY-97110GT-PT SESSION BY LICENSED PT 9 11.000000 885.1600 80.4691
PHY-97110TL-PT SESSION BY LICENSED PT 39 182.750000 14861.2300 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 8 10.000000 813.2000 81.3200
SENS-V5264-EARMOLD 2 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 448.340000 37103.9300 82.7585
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 28 50.750000 4306.0000 84.8473
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 105.500000 8579.2600 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 12.750000 1036.8300 81.3200
TRAV-TRAVS-Travel by mile 632 37006.00000 16461.9500 0.4448
Subtotal (Total Children Is Unduplicated) 1096 50030.02000 469790.6100 9.3902
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CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 55883.770000 717853.8200 12.8455
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Number of Children (Unduplicated) With at Least One Service 1631
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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 153 152.500000 7327.3600 74.4200
P 4148 3779.010000 190707.1500 187582.8800
D 483 571.700000 25731.2900 431.7600
S 46 46.810000 1599.7400 0.0000
H 23 24.000000 1934.8000 0.0000
T 7387 41587.610000 149466.5500 149466.5500
11519 9613.640000 334657.5900 0.0000
Other 123 108.500000 6429.3400 2045.0600
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Total 23882 55883.770000 717853.8200 339600.6700