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: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 687 463.500000 17242.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 100 92.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 826 2416.250000 89665.1600 37.1092
Subtotal (Total Children Is Unduplicated) 1210 2972.250000 106907.3600 35.9685
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 9.000000 436.5000 48.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 5.000000 404.9000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 3.000000 242.9400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 10.500000 659.1200 62.7733
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 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.500000 1660.0900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 28.000000 2267.4400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 21.500000 1741.0700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 63.500000 3804.9200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 47 91.500000 5482.6800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3563.1200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
Subtotal (Total Children Is Unduplicated) 126 323.000000 22282.3900 68.9857
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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 613 1973.000000 54.0000 0.0274
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 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 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 568 28645.00000 12743.1400 0.4449
Subtotal (Total Children Is Unduplicated) 1121 36679.50000 180822.9300 4.9298
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Total 39974.750000 310012.6800 7.7552
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Number of Children (Unduplicated) With at Least One Service 1655
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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 216 150.750000 6870.6800 0.0000
S 27 21.500000 704.1600 0.0000
H 0 0.000000 0.0000 0.0000
T 1239 8114.750000 22189.7500 22189.7500
13813 31667.250000 279353.1300 0.0000
Other 24 20.500000 894.9600 0.0000
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Total 15319 39974.750000 310012.6800 22189.7500