CMS/EIP Fiscal Report Center: 04
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 113 134.750000 5012.7000 37.2000
Subtotal (Total Children Is Unduplicated) 113 134.750000 5012.7000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
OCTH-97165-OT EVAL LOW COMPLEXITY 8 8.000000 464.8800 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 348.6600 58.1100
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 10 10.000000 581.1000 58.1100
Subtotal (Total Children Is Unduplicated) 28 31.000000 1801.4100 58.1100
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 21 31.000000 1550.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 100 2197.000000 59319.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 920 5883.000000 317682.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 46.750000 2524.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 763 4871.000000 73065.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 180 1170.000000 14040.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 39 118.500000 9636.4200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 40 143.000000 9312.1600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 43 119.000000 9677.0800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 32 109.000000 7098.0800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 66 218.500000 17768.4200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 52.500000 3418.8000 65.1200
Subtotal (Total Children Is Unduplicated) 1059 14961.25000 525191.4600 35.1034
-----------------------------------------------------------------------------------------------------------------------
Total 15127.000000 532005.5700 35.1693
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1084
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 19.000000 706.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 149 77.500000 2883.0000 0.0000
P 7775 7728.000000 179884.9200 179884.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4484 4469.000000 243337.1000 363.0000
T 0 0.000000 0.0000 0.0000
2053 2770.500000 100523.7500 0.0000
Other 102 63.000000 4670.0000 69.0000
---------------------------------------------------------
Total 14582 15127.000000 532005.5700 180316.7200