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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 5 1.250000 46.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 2.250000 83.7000 37.2000
Subtotal (Total Children Is Unduplicated) 9 3.500000 130.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 24.000000 1781.5600 74.2317
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 114.000000 8907.8000 78.1386
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 38.000000 3077.2400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1198.4000 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 8 8.000000 431.8400 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 7.000000 406.7700 58.1100
Subtotal (Total Children Is Unduplicated) 89 227.000000 16877.8300 74.3517
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 6.000000 300.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 25 28.500000 1425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 13.750000 343.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 21 22.750000 1125.0000 49.4505
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 1.250000 62.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.250000 62.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 51.250000 2562.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 229 1020.500000 55068.8500 53.9626
EPIC-99601-Early Steps Professional Development Fee 206 965.000000 14475.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 114 427.000000 5124.0000 12.0000
OCCT-97530GO-OT SESSION BY LICENSED OT 7 17.000000 1382.4400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 12 22.000000 1789.0400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 8 13.000000 846.5600 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 11 30.000000 2439.6000 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 7 36.000000 2344.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 116.250000 8965.5300 77.1228
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 19 61.000000 4960.5200 81.3200
TRAV-TRAVS-Travel by mile 140 7168.000000 3188.9600 0.4449
Subtotal (Total Children Is Unduplicated) 319 10008.50000 106828.5700 10.6738
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Total 10239.000000 123836.6000 12.0946
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Number of Children (Unduplicated) With at Least One Service 384
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Center 52
Flag Claims Units Chgs Paid
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R 1 0.250000 9.3000 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2677 9332.250000 66062.9300 66062.9300
849 906.500000 57764.3700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3527 10239.000000 123836.6000 66062.9300