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
Payclass Filters:GR
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 433 690.500000 25612.2000 37.0923
Subtotal (Total Children Is Unduplicated) 587 844.750000 30494.7000 36.0991
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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-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 12 19.000000 1538.6200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 29.500000 2388.9100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 115.500000 6920.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 8.000000 464.8800 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 91 194.500000 12588.8700 64.7243
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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 190 685.250000 37003.5000 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 12 33.000000 2683.5600 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 17 49.000000 3984.6800 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 96.750000 7867.7100 81.3200
TRAV-TRAVS-Travel by mile 434 28624.00000 12734.4600 0.4449
Subtotal (Total Children Is Unduplicated) 545 31624.00000 104757.3800 3.3126
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Total 32663.250000 147840.9500 4.5262
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Number of Children (Unduplicated) With at Least One Service 938
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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 633 3768.750000 14163.8300 14163.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1047 6118.750000 24966.2300 24966.2300
T 0 0.000000 0.0000 0.0000
4286 22775.750000 108710.8900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5966 32663.250000 147840.9500 39130.0600