CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 4 3.500000 175.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 20.500000 1660.0900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 34.500000 2663.4200 77.2006
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 958.7200 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 8.000000 464.8800 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 4.000000 232.4400 58.1100
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 48 99.500000 6941.9800 69.7686
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 66 63.500000 3120.8000 49.1465
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 30 24.000000 1200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 6.000000 300.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 24.000000 1200.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 9 11.000000 550.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 22.750000 1137.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 42.750000 2137.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 13 17.750000 887.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 192 693.250000 37435.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 56.000000 3024.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 235 869.000000 13035.0000 15.0000
INTR-T1013-INTERPRETER 6 17.000000 1190.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 290 966.000000 11592.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 49.000000 3984.6800 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 26 67.000000 5381.4200 80.3197
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 173.750000 13796.5800 79.4048
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 433 28600.00000 12723.7800 0.4449
Subtotal (Total Children Is Unduplicated) 542 31712.00000 113346.7500 3.5743
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Total 31811.500000 120288.7300 3.7813
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Number of Children (Unduplicated) With at Least One Service 559
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Center 03
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 641 3773.750000 14656.7100 14656.7100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1055 6101.750000 25553.7300 25553.7300
T 0 0.000000 0.0000 0.0000
3108 21936.000000 80078.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4804 31811.500000 120288.7300 40210.4400