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
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 101 161.750000 5998.5000 37.0850
Subtotal (Total Children Is Unduplicated) 101 161.750000 5998.5000 37.0850
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 43 86.000000 4300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 242.9400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.500000 769.3100 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 8 15.000000 1214.7000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 479.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 16.500000 988.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 76.500000 6194.9700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 76 144.500000 11701.6100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 47 89.500000 7247.7100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 130 240.500000 19475.6900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 27 52.500000 4251.4500 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 23 44.500000 3603.6100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 90 155.500000 9317.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 130 228.500000 13723.3100 60.0582
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 3 3.000000 174.3300 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 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) 507 1663.000000 110669.1600 66.5479
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 112 202.000000 10100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 46 50.750000 1268.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 10.000000 450.0000 45.0000
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 13 13.000000 650.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 14.000000 700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 982 5700.000000 307695.0000 53.9816
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 16 28.000000 1512.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 851 5935.000000 41181.0000 6.9387
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 167 907.000000 10776.0000 11.8809
OCCT-97530-OT SESSION BY LICENSED OT 114 664.500000 54037.1400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 23 135.000000 8739.8700 64.7398
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 252 1531.250000 122165.9700 79.7819
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 1164 98012.00000 43630.0100 0.4451
Subtotal (Total Children Is Unduplicated) 1266 114538.7500 709783.0900 6.1969
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Total 116363.500000 826450.7500 7.1023
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Number of Children (Unduplicated) With at Least One Service 1579
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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 11346 57331.250000 291077.9400 291077.9400
D 231 880.500000 5224.9600 81.3200
S 1087 6627.750000 31861.2800 0.0000
H 300 482.500000 28615.0100 0.0000
T 5750 25951.750000 149343.5900 149343.5900
7254 24654.750000 288218.5500 55600.8500
Other 225 435.000000 32109.4200 0.0000
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Total 26193 116363.500000 826450.7500 496103.7000