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:TPIN
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 8 6.500000 325.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.500000 1102.5000 71.1290
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 76.500000 4245.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 46.000000 2446.0000 53.1739
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 24.500000 1798.5000 73.4082
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 19.500000 1462.5000 75.0000
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 219.0400 54.7600
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 25.000000 1285.2500 51.4100
Subtotal (Total Children Is Unduplicated) 124 231.500000 13673.0900 59.0630
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 475 3061.750000 153063.5000 49.9922
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 80 311.500000 15575.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 120.000000 8756.8800 72.9740
OCCT-97530GT-OT SESSION BY LICENSED OT 4 16.000000 1151.3600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 54 366.500000 26194.4200 71.4718
PHY-97110GT-PT SESSION BY LICENSED PT 5 10.750000 782.9300 72.8307
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 575.500000 41628.2600 72.3341
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 49.500000 3580.7400 72.3382
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 4.000000 55.8400 13.9600
Subtotal (Total Children Is Unduplicated) 577 4522.500000 251074.9300 55.5168
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Total 4754.000000 264748.0200 55.6895
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Number of Children (Unduplicated) With at Least One Service 632
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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 4643 4711.000000 262236.2300 262176.2300
D 42 42.000000 2439.8300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.9600 71.9600
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4686 4754.000000 264748.0200 262248.1900