CMS/EIP Fiscal Report Center: 51
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.000000 586.5000 53.3182
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 18.000000 1312.5000 72.9167
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 262.5000 65.6250
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 223.5000 55.8750
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 13.500000 975.0000 72.2222
Subtotal (Total Children Is Unduplicated) 26 55.000000 3697.5000 67.2273
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 27.000000 1350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 3 4.000000 60.0000 15.0000
INTR-T1013-INTERPRETER 1 2.000000 60.0000 30.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14 48.000000 576.0000 12.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 10.000000 719.6000 71.9600
TRAV-TRAVS-Travel by mile 2 158.000000 70.3000 0.4449
Subtotal (Total Children Is Unduplicated) 19 250.000000 2885.9000 11.5436
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Total 305.000000 6583.4000 21.5849
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Number of Children (Unduplicated) With at Least One Service 33
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Center 51
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 84 270.000000 4673.4000 4673.4000
D 0 0.000000 0.0000 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
33 35.000000 1910.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 117 305.000000 6583.4000 4673.4000