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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1161 2048.000000 76279.8000 37.2460
TCM-T1017TL-TARGETED CASE MANAGEMENT 1568 4520.250000 168153.3000 37.2000
Subtotal (Total Children Is Unduplicated) 1748 6568.250000 244433.1000 37.2143
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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 11 17.500000 1417.1500 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 12 22.500000 1822.0500 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 242.9400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 14 22.500000 1348.2000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 30.000000 1797.6000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 128 210.500000 17046.2900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 160 284.500000 23079.3000 81.1223
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 83 154.500000 12511.4100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 242 439.000000 35550.2200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 52 99.000000 8017.0200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 48 90.500000 7328.6900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 233 407.500000 24501.6400 60.1267
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 407 723.500000 43558.0300 60.2046
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) 955 3385.000000 225260.1200 66.5466
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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 97 455.250000 22762.5000 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 1167 98092.00000 43665.6100 0.4451
Subtotal (Total Children Is Unduplicated) 1373 115600.0000 757034.0700 6.5487
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Total 125553.250000 1226727.2900 9.7706
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Number of Children (Unduplicated) With at Least One Service 2233
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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 13838 60029.750000 397364.0500 397364.0500
D 231 880.500000 5224.9600 81.3200
S 1087 6627.750000 31861.2800 0.0000
H 2297 2925.750000 146840.5500 101239.7900
T 7351 27736.500000 223799.2400 223799.2400
9098 26769.000000 378484.8100 56977.5100
Other 305 584.000000 43152.4000 0.0000
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Total 34207 125553.250000 1226727.2900 779461.9100