CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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 8 7.750000 288.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 80 131.250000 4882.5000 37.2000
Subtotal (Total Children Is Unduplicated) 81 139.000000 5170.8000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.1900 15.1900
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 21.4600 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 41.000000 2456.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 329.5600 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 8.000000 464.8800 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 290.5500 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 232.4400 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 10.000000 581.1000 58.1100
Subtotal (Total Children Is Unduplicated) 52 87.500000 4981.6600 56.9333
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.500000 75.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 80 81.000000 4050.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 30 30.000000 1500.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 145 145.000000 7250.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 84 84.000000 4200.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 474.000000 12798.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1245 8056.750000 435064.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 33 72.000000 3888.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 913 5796.000000 86940.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 375 2181.000000 26172.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 192.500000 15654.1000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 35 121.500000 7912.0800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 19 48.000000 3903.3600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 23 93.500000 6088.7200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 146.250000 11893.0500 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 23 52.500000 3418.8000 65.1200
TRAV-TRAVS-Travel by mile 9 2757.000000 1226.8200 0.4450
Subtotal (Total Children Is Unduplicated) 1314 20339.50000 632572.3500 31.1007
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Total 20566.000000 642724.8100 31.2518
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Number of Children (Unduplicated) With at Least One Service 1369
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Center 57
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 114 114.000000 3591.2800 0.0000
S 0 0.000000 0.0000 0.0000
H 73 84.750000 3066.5000 2966.7000
T 7037 8483.250000 185668.9800 185668.9800
10603 11884.000000 450398.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17827 20566.000000 642724.8100 188635.6800