CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
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 905 731.000000 27193.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 105 70.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 708 2361.250000 87838.5000 37.2000
Subtotal (Total Children Is Unduplicated) 1107 3162.250000 115031.7000 36.3765
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1318.2400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 78.000000 6316.4400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 971.7600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 30.000000 2429.4000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 46.000000 3725.0800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 71.000000 4254.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 8.804509 511.6300 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 7 6.061607 352.2400 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 4.654276 270.4600 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 5.924626 344.2800 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 6.509895 378.2900 58.1100
Subtotal (Total Children Is Unduplicated) 132 327.954913 23634.9300 72.0676
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 242.8000 121.4000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 9.500000 475.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 111 111.500000 5575.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 82 74.500000 1862.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 29 57.000000 2850.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 27 91.000000 2275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 106 106.000000 5300.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 4 4.000000 200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 84 76.500000 1912.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 176 1133.750000 61222.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 33.750000 1822.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 336 2445.000000 36675.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 404 2805.000000 33660.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 174.728112 14208.8900 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 25 161.759056 10512.0900 64.9861
PHY-97110-PT SESSION BY LICENSED PT 25 110.240162 8964.7300 81.3200
PHY-97110HM-PT SESSION BY PT ASST 17 90.361479 5884.3400 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 0.750000 48.8400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 93 457.914046 37237.5700 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 12.000000 975.8400 81.3200
Subtotal (Total Children Is Unduplicated) 749 7964.752855 232242.6000 29.1588
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Total 11454.957768 370909.2300 32.3798
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Number of Children (Unduplicated) With at Least One Service 1233
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Center 55
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 8107 7941.332585 234972.2600 234988.1600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 119.8400 0.0000
T 10 9.125183 480.4800 480.4800
4771 3502.500000 135336.6500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 12889 11454.957768 370909.2300 235468.6400