CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
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 1079 1932.000000 71964.6000 37.2488
TCM-T1017TL-TARGETED CASE MANAGEMENT 1406 4112.250000 152957.1000 37.1955
Subtotal (Total Children Is Unduplicated) 1577 6044.250000 224921.7000 37.2125
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 209 366.000000 18300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.000000 728.8200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 13.500000 1093.2300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 18.500000 1498.1300 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.500000 749.0000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 14 26.000000 1557.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 96 162.500000 13159.2500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 110 203.500000 16479.4300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 62 117.000000 9474.6600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 152 283.000000 22917.3400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 63.500000 5142.2300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 34 67.000000 5425.6600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 165 294.500000 17688.5600 60.0630
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 260 477.500000 28643.3900 59.9862
NUTR-97802-NUTRITIONAL EVAL, INITIAL 9 56.000000 2800.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 24 139.000000 6950.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 313.7600 62.7520
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 27 279.000000 16212.6900 58.1100
Subtotal (Total Children Is Unduplicated) 732 2616.500000 170625.4400 65.2113
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 123 225.250000 11262.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 7 9.500000 475.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 53 56.250000 1406.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 11.000000 500.0000 45.4545
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 20.500000 1025.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 17.000000 850.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 15.000000 750.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 6 6.000000 300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 60 148.750000 161.9600 1.0888
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1015 5858.000000 316227.0000 53.9821
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 40.000000 2160.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 851 5935.000000 41181.0000 6.9387
INTR-T1013-INTERPRETER 85 406.000000 20300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 167 907.000000 10776.0000 11.8809
OCCT-97530-OT SESSION BY LICENSED OT 119 689.500000 56070.1400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 5 6.000000 487.9200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 23 135.000000 8739.8700 64.7398
OCCT-97530TLGO-OT SESSION BY LICENSED OT 4 15.000000 1219.8000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 194 1281.750000 103418.7100 80.6856
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 5 22.000000 1432.6400 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 459.2200 229.6100
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 267 1616.250000 129078.1700 79.8628
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 406.6000 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 16.000000 1301.1200 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 569.2400 81.3200
TRAV-TRAVS-Travel by mile 1164 98012.00000 43630.0100 0.4451
Subtotal (Total Children Is Unduplicated) 1358 115470.7500 754535.9700 6.5344
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Total 124131.500000 1150083.1100 9.2650
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Number of Children (Unduplicated) With at Least One Service 2005
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Center 09
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 13661 59723.750000 384683.4600 384683.4600
D 231 880.500000 5224.9600 81.3200
S 1087 6627.750000 31861.2800 0.0000
H 1940 2376.250000 115030.1300 85987.3200
T 7224 27553.250000 214353.6200 214353.6200
8970 26533.000000 366700.4000 55600.8500
Other 226 437.000000 32229.2600 0.0000
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Total 33339 124131.500000 1150083.1100 740706.5700