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
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 5 1.250000 46.5000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 2.000000 74.4000 37.2000
Subtotal (Total Children Is Unduplicated) 8 3.250000 120.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
Subtotal (Total Children Is Unduplicated) 4 10.000000 767.6800 76.7680
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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 1 0.750000 37.5000 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 16 85.000000 4590.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 206 964.000000 14460.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 114 427.000000 5124.0000 12.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 12.000000 975.8400 81.3200
TRAV-TRAVS-Travel by mile 140 7168.000000 3188.9600 0.4449
Subtotal (Total Children Is Unduplicated) 318 8788.250000 34557.5500 3.9322
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Total 8801.500000 35446.1300 4.0273
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Number of Children (Unduplicated) With at Least One Service 326
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2169 8798.250000 35325.2300 35325.2300
9 3.250000 120.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2178 8801.500000 35446.1300 35325.2300