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:EIP DEI DEIP
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
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 1 2.000000 161.9600 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 599.2000 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 19 36.000000 2891.3600 80.3156
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 34.500000 2793.8100 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 67 127.500000 10767.6000 84.4518
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 364.4100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 12 22.000000 1781.5600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.500000 1048.6000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 48 97.000000 5887.6400 60.6973
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 50.000000 4013.1200 80.2624
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 30.000000 2429.4000 80.9800
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 228 538.000000 41029.4700 76.2630
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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 16 33.000000 2383.6800 72.2327
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 44 39.000000 1927.0000 49.4103
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 113 102.750000 5150.0000 50.1217
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 3.500000 162.5000 46.4286
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 172 70.250000 3550.0000 50.5338
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 36 35.000000 1750.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 114 38.750000 1950.0000 50.3226
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 64 70.250000 3512.5000 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
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 116 417.000000 22597.0000 54.1894
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 39 101.000000 5454.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 403 1318.000000 20004.9600 15.1783
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 154 681.000000 8184.0000 12.0176
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 25 103.500000 8430.2200 81.4514
PHY-97110GT-PT SESSION BY LICENSED PT 5 7.000000 559.8800 79.9829
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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 202.590000 17119.2100 84.5018
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 22.750000 2029.0400 89.1886
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
Subtotal (Total Children Is Unduplicated) 702 6438.020000 208522.5400 32.3892
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Total 11876.270000 429311.7100 36.1487
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Number of Children (Unduplicated) With at Least One Service 1559
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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 0 0.000000 0.0000 0.0000
9176 7193.750000 195582.0300 0.0000
Other 123 108.500000 6429.3400 2045.0600
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Total 14152 11876.270000 429311.7100 190134.1200