CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
Subtotal (Total Children Is Unduplicated) 3 5.500000 344.2500 62.5909
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 182.000000 9108.0000 50.0440
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 13.000000 650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 26.000000 1870.9600 71.9600
Subtotal (Total Children Is Unduplicated) 81 228.000000 12132.6800 53.2135
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Total 233.500000 12476.9300 53.4344
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Number of Children (Unduplicated) With at Least One Service 84
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Center 01
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 5 5.000000 250.0000 250.0000
D 225 227.500000 12176.9300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 231 233.500000 12476.9300 250.0000