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:EIP DEI DEIP
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 474 265.750000 9858.2500 37.0960
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 12.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 356 1006.250000 37246.5000 37.0152
Subtotal (Total Children Is Unduplicated) 651 1284.000000 47104.7500 36.6859
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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-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 2 4.000000 323.9200 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 2 4.000000 323.9200 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 35 70.000000 4194.4000 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) 47 101.000000 6367.4400 63.0440
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 38.250000 1943.8200 50.8188
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 17.750000 887.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 9.500000 237.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 35 49.000000 2450.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 26.500000 1325.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.250000 12.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.250000 475.0000 57.5758
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 35.000000 1750.0000 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 25 88.250000 4779.0000 54.1530
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 14.000000 756.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 211 965.000000 14469.0000 14.9938
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 198 794.000000 9528.0000 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
TRAV-TRAVS-Travel by mile 240 16203.00000 7208.0200 0.4449
Subtotal (Total Children Is Unduplicated) 413 18539.75000 47777.7300 2.5770
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Total 19924.750000 101249.9200 5.0816
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Number of Children (Unduplicated) With at Least One Service 789
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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 2944 18105.000000 38566.1900 37450.9000
2857 1811.750000 62395.4300 30.0000
Other 0 0.000000 0.0000 0.0000
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Total 5809 19924.750000 101249.9200 37480.9000