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
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
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-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 10.000000 809.8000 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 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1295.6800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 42.000000 3401.1600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 134.000000 8029.2800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 55 106.500000 6381.4800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 24.000000 1943.5200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1133.7200 80.9800
Subtotal (Total Children Is Unduplicated) 195 415.500000 27274.0400 65.6415
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 17.000000 2364.4600 139.0859
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 43 33.250000 1662.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 83 87.750000 4387.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 38 41.500000 2075.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 16 16.750000 837.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 41.000000 1134.0000 27.6585
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 494 2450.500000 132323.0000 53.9984
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 208 445.000000 24030.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 385 1848.000000 27720.0000 15.0000
INTR-T1013-INTERPRETER 2 5.500000 217.1600 39.4836
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 291 1178.000000 14136.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 35 136.000000 11059.5200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 325.2800 81.3200
SENS-V5264-EARMOLD 2 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 245.750000 19984.7200 81.3213
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 28.000000 2276.9600 81.3200
TRAV-TRAVS-Travel by mile 632 37006.00000 16461.9500 0.4448
Subtotal (Total Children Is Unduplicated) 703 43592.00000 261268.0700 5.9935
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Total 44007.500000 288542.1100 6.5567
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Number of Children (Unduplicated) With at Least One Service 757
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7387 41587.610000 149466.5500 149466.5500
2343 2419.890000 139075.5600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9730 44007.500000 288542.1100 149466.5500