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
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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 14.000000 1133.7200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 34.500000 2067.2400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.500000 1827.5600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
Subtotal (Total Children Is Unduplicated) 51 102.000000 6619.7600 64.8996
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 16.000000 2284.9300 142.8081
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 1 1.000000 27.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 99 422.500000 22815.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 52 114.500000 6183.0000 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 10 32.000000 2602.2400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 15.000000 1219.8000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 632 37006.00000 16461.9500 0.4448
Subtotal (Total Children Is Unduplicated) 675 40825.75000 103028.4800 2.5236
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Total 40927.750000 109648.2400 2.6791
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Number of Children (Unduplicated) With at Least One Service 693
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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 6737 40926.750000 109594.2400 109594.2400
3 1.000000 54.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6740 40927.750000 109648.2400 109594.2400