CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
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 163 62.000000 2306.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2362 5496.250000 205371.9000 37.3658
Subtotal (Total Children Is Unduplicated) 2380 5558.250000 207678.3000 37.3640
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
EXIT-EXIT-COS Exit 58 65.000000 3275.0000 50.3846
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 242.9400 60.7350
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 73.000000 4224.3600 57.8679
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 29.500000 1767.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 25.500000 2145.9700 84.1557
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1579.1100 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 8.000000 464.8800 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 13.000000 801.8500 61.6808
Subtotal (Total Children Is Unduplicated) 166 270.500000 16572.0900 61.2647
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 114 121.000000 5978.0000 49.4050
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 84 104.000000 5212.5000 50.1202
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 39 41.750000 1075.0000 25.7485
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 94 138.500000 6925.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 123 288.000000 11400.0000 39.5833
CONIP-CONIP-CONSULT, ITDS PHONE 10 11.750000 293.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 12.000000 600.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 60 116.750000 5837.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 41.250000 2062.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 35 49.000000 2450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 69 94.000000 4700.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 57 103.000000 5150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 4.500000 137.5000 30.5556
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 54.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 527 2960.000000 159797.0000 53.9855
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 82 248.250000 13402.5000 53.9879
EPIC-99601-Early Steps Professional Development Fee 283 1602.000000 24030.0000 15.0000
INTR-T1013-INTERPRETER 86 199.250000 11324.8500 56.8374
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1271 8057.000000 96684.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 96.000000 7806.7200 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 48 233.250000 18875.1700 80.9225
PHY-97110GT-PT SESSION BY LICENSED PT 8 20.750000 1623.3900 78.2357
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 63 342.500000 27852.1000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 29.000000 2358.2800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 11.000000 716.3200 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 1.000000 65.1200 65.1200
TRAV-TRAVS-Travel by mile 325 22240.00000 9903.8300 0.4453
Subtotal (Total Children Is Unduplicated) 1607 37177.50000 426927.9500 11.4835
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Total 43006.250000 651178.3400 15.1415
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Number of Children (Unduplicated) With at Least One Service 2776
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Center 01
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 13811 33742.750000 350970.1500 350958.1500
D 344 627.000000 13104.6000 0.0000
S 897 674.000000 25072.8000 0.0000
H 3276 2337.750000 87698.2200 87400.2600
T 2606 3051.250000 77557.5500 77780.7100
3950 2566.250000 96505.3200 54.0000
Other 16 7.250000 269.7000 0.0000
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Total 24900 43006.250000 651178.3400 516193.1200