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
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 8 7.750000 288.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 29 47.000000 1748.4000 37.2000
Subtotal (Total Children Is Unduplicated) 34 54.750000 2036.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 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 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 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 10 15.000000 878.8900 58.5927
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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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 481 3347.750000 180778.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 21.000000 1134.0000 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 6 25.000000 2033.0000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 2 7.500000 609.9000 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 325.6000 65.1200
TRAV-TRAVS-Travel by mile 9 2757.000000 1226.8200 0.4450
Subtotal (Total Children Is Unduplicated) 1250 14485.75000 316588.7800 21.8552
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Total 14555.500000 319504.3700 21.9508
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Number of Children (Unduplicated) With at Least One Service 1275
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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 109 109.000000 3212.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7016 8461.250000 184026.9500 184026.9500
4554 5985.250000 132265.4200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11679 14555.500000 319504.3700 184026.9500