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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 43 86.000000 4300.0000 50.0000
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 9 18.000000 1457.6400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 22.000000 1781.5600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 769.3100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.000000 539.2800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.000000 1050.2300 61.7782
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-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166GT-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 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 39.000000 2266.2900 58.1100
Subtotal (Total Children Is Unduplicated) 122 410.500000 23014.6600 56.0649
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 109 195.500000 9775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 46 49.750000 1243.7500 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 11 11.000000 550.0000 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 456 2596.000000 140079.0000 53.9596
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 12.000000 648.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 834 5535.000000 39297.0000 7.0997
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 167 907.000000 10776.0000 11.8809
OCCT-97530-OT SESSION BY LICENSED OT 39 190.000000 15450.8000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 6 21.000000 1367.5200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 55 299.000000 24314.6800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 9.000000 586.0800 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 57 346.750000 27465.8300 79.2093
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 1144 93398.00000 41578.0500 0.4452
Subtotal (Total Children Is Unduplicated) 1211 103621.5000 315730.9100 3.0470
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Total 104032.000000 338745.5700 3.2562
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Number of Children (Unduplicated) With at Least One Service 1250
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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 9513 53740.250000 177363.1100 177363.1100
D 169 818.500000 3043.2300 0.0000
S 876 6416.000000 17537.6900 0.0000
H 0 0.000000 0.0000 0.0000
T 4276 22128.500000 76886.5700 76886.5700
3542 20889.750000 61041.0600 0.0000
Other 20 39.000000 2873.9100 0.0000
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Total 18396 104032.000000 338745.5700 254249.6800