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
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 163 62.000000 2306.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1169 2498.500000 93864.9000 37.5685
Subtotal (Total Children Is Unduplicated) 1260 2560.500000 96171.3000 37.5596
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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 56 63.000000 3175.0000 50.3968
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 242.9400 60.7350
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.000000 958.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 242.9400 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 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 7.000000 406.7700 58.1100
Subtotal (Total Children Is Unduplicated) 84 109.500000 5924.2500 54.1027
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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 178 797.500000 43065.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 28 70.750000 3817.5000 53.9576
EPIC-99601-Early Steps Professional Development Fee 283 1602.000000 24030.0000 15.0000
INTR-T1013-INTERPRETER 86 198.250000 11274.8500 56.8719
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1271 8057.000000 96684.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 17.000000 1382.4400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 16 46.500000 3738.4600 80.3970
PHY-97110GT-PT SESSION BY LICENSED PT 2 8.000000 650.5600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 56.250000 4574.2500 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 325.2800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 5.000000 325.6000 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) 1589 34235.75000 251918.9600 7.3584
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Total 36905.750000 354014.5100 9.5924
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Number of Children (Unduplicated) With at Least One Service 2315
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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 11471 31370.750000 209065.2700 209053.2700
D 209 490.500000 4850.7500 0.0000
S 2 1.500000 55.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 2043 2481.000000 43773.1900 44038.4700
3944 2562.000000 96269.5000 54.0000
Other 0 0.000000 0.0000 0.0000
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Total 17669 36905.750000 354014.5100 253145.7400