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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 208 131.250000 4882.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 23.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 796 1462.500000 54330.6000 37.1491
Subtotal (Total Children Is Unduplicated) 902 1616.750000 59213.1000 36.6248
-----------------------------------------------------------------------------------------------------------------------
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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 35.500000 2874.7900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 57.500000 4525.9600 78.7123
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 125.500000 7519.9600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.000000 539.2800 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 5 5.000000 269.9000 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) 117 262.000000 17455.5000 66.6240
-----------------------------------------------------------------------------------------------------------------------
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 33 58.000000 3132.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 235 869.000000 13035.0000 15.0000
INTR-T1013-INTERPRETER 9 22.000000 1610.0000 73.1818
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 291 967.000000 11604.0000 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 434 28624.00000 12734.4600 0.4449
Subtotal (Total Children Is Unduplicated) 548 31744.00000 113897.4300 3.5880
-----------------------------------------------------------------------------------------------------------------------
Total 33622.750000 190566.0300 5.6678
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1153
-----------------------------------------------------------------------------------------------------------------------
Center 03
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 644 3779.750000 15058.3500 15058.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1061 6132.750000 26077.3900 26077.3900
T 0 0.000000 0.0000 0.0000
5494 23710.250000 149430.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7199 33622.750000 190566.0300 41135.7400