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
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
Screening, Eval, and Assessment,Class #02
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 1 2.000000 119.8400 59.9200
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 15 34.000000 2037.2800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 14.500000 868.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
Subtotal (Total Children Is Unduplicated) 30 64.500000 4117.5600 63.8381
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 12.000000 3068.6500 255.7208
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 23.500000 1175.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 48 46.250000 2312.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 40 45.750000 2287.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 6 7.000000 350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 1.250000 62.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 0.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 87 282.750000 15268.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 37 62.250000 3361.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 337 1208.000000 18120.0000 15.0000
INTR-T1013-INTERPRETER 2 4.000000 137.8600 34.4650
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 250 786.000000 9432.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 8 16.000000 1301.1200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 13.000000 1057.1600 81.3200
TRAV-TRAVS-Travel by mile 538 27974.00000 12444.6500 0.4449
Subtotal (Total Children Is Unduplicated) 575 30485.75000 70541.4400 2.3139
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Total 30550.250000 74659.0000 2.4438
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Number of Children (Unduplicated) With at Least One Service 584
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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 0 0.000000 0.0000 0.0000
S 4 3.750000 134.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 1225 8062.750000 21635.4000 21635.4000
3183 22483.750000 52889.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4412 30550.250000 74659.0000 21635.4000