CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
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 475 267.000000 9904.7500 37.0964
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 12.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 357 1008.250000 37320.9000 37.0155
Subtotal (Total Children Is Unduplicated) 653 1287.250000 47225.6500 36.6872
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 72.000000 4314.2400 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 48 111.000000 7135.1200 64.2804
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 44.250000 2243.8200 50.7078
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 41 46.250000 2312.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 23.250000 581.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 52 71.750000 3575.0000 49.8258
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 2.750000 137.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 27.750000 1387.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 28 59.500000 3037.5000 51.0504
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 41.000000 2050.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 2 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 190 263.250000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 41 173.250000 9369.0000 54.0779
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 14.000000 756.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 392 1929.000000 28929.0000 14.9969
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 303 1221.000000 14652.0000 12.0000
OCCT-97530HM-OT SESSION BY OT ASST 1 5.000000 325.6000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 3 15.750000 1280.7900 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 12.000000 975.8400 81.3200
TRAV-TRAVS-Travel by mile 359 23371.00000 10396.9800 0.4449
Subtotal (Total Children Is Unduplicated) 660 27328.00000 82335.2800 3.0129
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Total 28726.250000 136696.0500 4.7586
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Number of Children (Unduplicated) With at Least One Service 888
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Center 52
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 8 8.000000 288.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 5113 26903.250000 73891.4200 72776.1300
2866 1815.000000 62516.3300 30.0000
Other 0 0.000000 0.0000 0.0000
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Total 7987 28726.250000 136696.0500 72806.1300