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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 687 463.750000 17251.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 100 92.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1677 5567.750000 206863.7600 37.1539
Subtotal (Total Children Is Unduplicated) 1731 6124.000000 224115.2600 36.5962
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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 3 6.500000 526.3700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.500000 850.2900 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.000000 1052.7400 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 8 17.000000 1018.6400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 34.000000 2067.2400 60.8012
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 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 24 42.500000 3441.6500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 30 58.500000 4737.3300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 67 126.500000 10203.4800 80.6599
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 77 144.000000 11661.1200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 25 49.500000 4008.5100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 164.000000 9826.8800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 129 255.000000 15279.6000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 111.000000 8988.7800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 36.000000 2915.2800 80.9800
SCREEN-T1023-SCREENING 5 6.000000 323.8800 53.9800
Subtotal (Total Children Is Unduplicated) 352 1124.500000 80842.3600 71.8918
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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 613 1973.000000 54.0000 0.0274
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 749 2846.000000 42705.0000 15.0053
INTR-T1013-INTERPRETER 2 4.000000 137.8600 34.4650
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 403 1426.000000 17112.0000 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 568 28645.00000 12743.1400 0.4449
Subtotal (Total Children Is Unduplicated) 1151 40011.25000 393844.0300 9.8433
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Total 47259.750000 698801.6500 14.7864
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Number of Children (Unduplicated) With at Least One Service 1831
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Center 54
Flag Claims Units Chgs Paid
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R 99 100.000000 4663.6100 0.0000
U 0 0.000000 0.0000 0.0000
B 1929 1851.000000 89445.1100 0.0000
P 2633 2450.530000 122471.9200 121842.8200
D 279 210.970000 11175.6700 0.0000
S 157 146.500000 5486.5200 0.0000
H 111 114.250000 8703.2500 0.0000
T 1365 8243.580000 30166.2200 29296.7400
15973 33978.170000 418739.1700 0.0000
Other 211 164.750000 7950.1800 719.1700
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Total 22757 47259.750000 698801.6500 151858.7300