CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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 5 2.000000 74.4000 37.2000
Subtotal (Total Children Is Unduplicated) 5 2.000000 74.4000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 15.8400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 63.6200 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 46.2800 23.1400
EXIT-EXIT-COS Exit 83 92.250000 4800.0000 52.0325
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 385.8800 64.3133
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 480.2800 80.0467
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 40.000000 2396.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 838.8800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 406.7700 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 8.000000 464.8800 58.1100
Subtotal (Total Children Is Unduplicated) 134 200.250000 11309.7400 56.4781
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 46.250000 2312.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 136 172.500000 8625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 10.500000 262.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 187 259.250000 12962.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 215 371.750000 18587.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 66 73.750000 3687.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 100 141.750000 7087.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 41.750000 2087.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 42 55.750000 2787.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 100 119.750000 5987.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 105 135.000000 6750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 2.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 522 2813.750000 151942.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 84 191.500000 10341.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 611 3401.000000 51015.0000 15.0000
INTR-T1013-INTERPRETER 1 3.250000 221.1000 68.0308
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 971 6309.000000 75714.0000 12.0010
OCCT-97530-OT SESSION BY LICENSED OT 21 95.500000 7275.2900 76.1810
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 9.3200 9.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 8.000000 520.9600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 29 129.000000 9664.1800 74.9161
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 135.500000 9517.4300 70.2393
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.750000 630.2300 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 24.000000 1562.8800 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 5 29.000000 1888.4800 65.1200
TRAV-TRAVS-Travel by mile 45 3098.000000 1378.0300 0.4448
Subtotal (Total Children Is Unduplicated) 1368 17686.25000 393276.9800 22.2363
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Total 17888.500000 404661.1200 22.6213
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Number of Children (Unduplicated) With at Least One Service 1381
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Center 07
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 14967 17884.500000 404586.7200 404583.7200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7 4.000000 74.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14974 17888.500000 404661.1200 404583.7200