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:EIP DEI DEIP
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
-----------------------------------------------------------------------------------------------------------------------
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 1 2.000000 161.9600 80.9800
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 4 7.500000 479.3600 63.9147
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 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 21.000000 1700.5800 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 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 13.500000 1093.2300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 16.500000 988.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 45 89.500000 5362.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 64.000000 5182.7200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 15.500000 1255.1900 80.9800
SCREEN-T1023-SCREENING 5 6.000000 323.8800 53.9800
Subtotal (Total Children Is Unduplicated) 215 498.000000 37614.6500 75.5314
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 5 5.000000 239.7000 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 18 35.000000 2528.3600 72.2389
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 33.500000 1760.3200 52.5469
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 102 113.250000 5675.0000 50.1104
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 2.500000 125.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 190 91.500000 4562.5000 49.8634
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 121 47.750000 2387.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 68 82.000000 4100.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 191 89.750000 4487.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 559 1923.250000 54.0000 0.0281
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 108 446.250000 24151.5000 54.1210
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 46 95.000000 5130.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 436 1570.000000 23550.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 141 612.000000 7344.0000 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 29 123.500000 10043.0200 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 48 178.500000 14515.6200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 28.750000 2337.9500 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
Subtotal (Total Children Is Unduplicated) 760 6967.500000 223053.0900 32.0134
-----------------------------------------------------------------------------------------------------------------------
Total 12779.250000 455450.8000 35.6399
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1651
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 84 83.750000 3923.9700 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 129 114.250000 4329.3200 0.0000
H 107 107.250000 8309.8500 0.0000
T 10 10.000000 670.3200 0.0000
10410 8334.750000 232932.7300 0.0000
Other 197 148.250000 7028.2600 719.1700
---------------------------------------------------------
Total 15364 12779.250000 455450.8000 108711.1100