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
Payclass Filters:GR
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 611 413.750000 15382.2000 37.1775
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 79 61.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 749 1913.750000 71033.4000 37.1174
Subtotal (Total Children Is Unduplicated) 1089 2389.250000 86415.6000 36.1685
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-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-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
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 6 11.500000 919.3100 79.9400
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 242.9400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 1052.7400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 25.500000 2064.9900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 2241.3600 62.2600
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 797.8400 79.7840
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 64 125.000000 9175.1900 73.4015
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 12 25.000000 1808.0000 72.3200
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 2 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 63.500000 3413.0000 53.7480
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 26.000000 1404.0000 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 15 75.000000 6042.8400 80.5712
OCCT-97530GO-OT SESSION BY LICENSED OT 17 58.000000 4675.9000 80.6190
OCCT-97530GOGT-OT SESSION BY LICENSED OT 9 14.250000 1158.8100 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 6 27.000000 1735.6800 64.2844
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 12 55.500000 4424.3400 79.7178
PHY-97110GT-PT SESSION BY LICENSED PT 2 4.000000 315.9200 78.9800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 116.750000 9233.4900 79.0877
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 8.750000 711.5500 81.3200
Subtotal (Total Children Is Unduplicated) 689 4714.750000 94634.0300 20.0719
-----------------------------------------------------------------------------------------------------------------------
Total 7229.000000 190224.8200 26.3141
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1292
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 260 176.250000 7709.9700 0.0000
S 27 31.250000 354.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8982 6991.750000 180974.9700 0.0000
Other 44 29.750000 1185.5800 0.0000
---------------------------------------------------------
Total 9313 7229.000000 190224.8200 0.0000