CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
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 658 442.000000 16442.4000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 78 72.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1539 4799.500000 178340.6600 37.1582
Subtotal (Total Children Is Unduplicated) 1593 5313.750000 194783.0600 36.6564
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 2 3.000000 350.4900 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.500000 769.3100 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 13.000000 778.9600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 17.000000 1048.6000 61.6824
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 29.000000 2348.4200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 41.500000 3360.6700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 85.000000 6883.3000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 53 99.000000 8017.0200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 971.7600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 21.500000 1741.0700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 98.500000 5902.1200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 79 155.000000 9287.6000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 80.000000 6478.4000 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1579.1100 80.9800
SCREEN-T1023-SCREENING 5 6.000000 323.8800 53.9800
Subtotal (Total Children Is Unduplicated) 233 718.000000 51892.1700 72.2732
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 5 5.000000 239.7000 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 29 49.000000 5757.3000 117.4959
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 57.000000 2935.3200 51.4968
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 144 159.500000 7987.5000 50.0784
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 44 48.250000 2412.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 195 98.500000 4912.5000 49.8731
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 43.250000 2162.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 297 163.250000 8162.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 47 54.000000 2700.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 123 49.000000 2450.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 69 83.000000 4150.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 192 90.750000 4537.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 560 1923.750000 54.0000 0.0281
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 20.000000 540.0000 27.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 544 2109.500000 113967.0000 54.0256
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 178 313.000000 16902.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 695 2778.000000 41670.0000 15.0000
INTR-T1013-INTERPRETER 2 4.000000 137.8600 34.4650
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 385 1398.000000 16776.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 49 236.750000 19252.5100 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 26 107.000000 8701.2400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 16 38.000000 3090.1600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 9.500000 772.5400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 14 75.000000 4884.0000 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 5 8.750000 569.8000 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 68 347.000000 28238.3700 81.3786
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 10 24.000000 1951.6800 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 8 11.000000 716.3200 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 19 80.000000 5209.6000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 52 187.500000 15247.5000 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.000000 325.2800 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 36 168.500000 13702.4200 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 6 6.250000 508.2500 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 312.500000 25412.5000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 39.250000 3191.8100 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 34 108.000000 8782.5600 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 243.9600 81.3200
TRAV-TRAVS-Travel by mile 538 27974.00000 12444.6500 0.4449
Subtotal (Total Children Is Unduplicated) 1077 39195.00000 392174.5400 10.0057
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Total 45226.750000 638849.7700 14.1255
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Number of Children (Unduplicated) With at Least One Service 1693
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Center 54
Flag Claims Units Chgs Paid
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R 86 85.250000 4045.9500 0.0000
U 0 0.000000 0.0000 0.0000
B 1764 1631.500000 79058.8600 0.0000
P 2389 2147.030000 108513.1400 107991.9400
D 274 202.470000 10684.3500 0.0000
S 133 118.000000 4463.5200 0.0000
H 107 107.250000 8309.8500 0.0000
T 1345 8183.580000 29113.1100 28442.7900
15322 32603.420000 387632.7300 0.0000
Other 197 148.250000 7028.2600 719.1700
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Total 21617 45226.750000 638849.7700 137153.9000