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
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 658 441.750000 16433.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 78 72.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 769 2095.750000 77779.7600 37.1131
Subtotal (Total Children Is Unduplicated) 1124 2609.750000 94212.8600 36.1003
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 359.5200 65.3673
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.500000 931.2700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.000000 1538.6200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 7.500000 607.3500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 41.500000 2486.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 29 56.500000 3385.4800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 32.000000 2591.3600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
Subtotal (Total Children Is Unduplicated) 78 197.000000 13468.8700 68.3699
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 30.000000 4373.6900 145.7897
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 46 53.000000 2650.0000 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
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 107 360.750000 19480.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 43 71.250000 3847.5000 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 25 136.750000 11120.5100 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 17 62.000000 5041.8400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 9 27.000000 2195.6400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 5.000000 406.6000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 8 42.000000 2735.0400 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 2 3.000000 195.3600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 22 78.500000 6383.6200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 102.500000 8335.3000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 14.500000 1179.1400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 3.500000 284.6200 81.3200
TRAV-TRAVS-Travel by mile 538 27974.00000 12444.6500 0.4449
Subtotal (Total Children Is Unduplicated) 1047 35863.25000 179153.4400 4.9955
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Total 38670.000000 286835.1700 7.4175
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Number of Children (Unduplicated) With at Least One Service 1542
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Center 54
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 211 142.250000 6379.3600 0.0000
S 26 20.500000 704.1600 0.0000
H 0 0.000000 0.0000 0.0000
T 1225 8062.750000 21635.4000 21635.4000
13232 30424.000000 257221.2900 0.0000
Other 24 20.500000 894.9600 0.0000
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Total 14718 38670.000000 286835.1700 21635.4000