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
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-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 239.6800 68.4800
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-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 449.4000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 42.000000 2516.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 26.000000 2105.4800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
Subtotal (Total Children Is Unduplicated) 61 132.500000 9351.3100 70.5759
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 18.000000 1305.0400 72.5022
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 45 52.000000 2600.0000 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 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 21 78.000000 4212.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 9.000000 486.0000 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 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 14 62.500000 5082.5000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 89.500000 7278.1400 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
Subtotal (Total Children Is Unduplicated) 746 5377.500000 108612.0000 20.1975
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Total 8119.750000 212176.1700 26.1309
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Number of Children (Unduplicated) With at Least One Service 1376
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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 22 16.750000 569.9600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10049 7940.250000 204331.8900 0.0000
Other 24 20.500000 894.9600 0.0000
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Total 10306 8119.750000 212176.1700 0.0000