CMS/EIP Fiscal Report Center: 57
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 16 8.000000 297.6000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 35 55.250000 2055.3000 37.2000
Subtotal (Total Children Is Unduplicated) 50 63.250000 2352.9000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 11.000000 639.2100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 290.5500 58.1100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 813.5400 58.1100
Subtotal (Total Children Is Unduplicated) 29 42.000000 2446.0500 58.2393
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 148 150.000000 7500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 70 70.000000 3500.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 14.000000 700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 275 276.000000 13800.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 143 143.000000 7150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 544 5383.000000 290682.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 38.000000 2052.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1032 10124.00000 151860.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 554 4077.000000 48924.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 43.000000 3496.7600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 3 10.000000 813.2000 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 4 24.500000 1992.3400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 13.000000 846.5600 65.1200
TRAV-TRAVS-Travel by mile 9 3097.000000 1378.1200 0.4450
Subtotal (Total Children Is Unduplicated) 1380 23468.50000 535057.6200 22.7990
-----------------------------------------------------------------------------------------------------------------------
Total 23573.750000 539856.5700 22.9008
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1432
-----------------------------------------------------------------------------------------------------------------------
Center 57
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 178 178.000000 4764.1100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 20367 23307.000000 532148.6800 532148.6800
97 88.750000 2943.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20642 23573.750000 539856.5700 532148.6800