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
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
Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.500000 112.5000 45.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 16 28.000000 1550.5000 55.3750
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 39.500000 3150.0000 79.7468
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.000000 221.9600 73.9867
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 8.500000 643.4800 75.7035
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 10.000000 411.0000 41.1000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 17.500000 1312.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 18 20.000000 1028.2000 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 411.2800 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 10 10.000000 514.1000 51.4100
Subtotal (Total Children Is Unduplicated) 82 152.500000 9729.0200 63.7969
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 132.0000 132.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 10 9.250000 437.5000 47.2973
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 63 387.000000 19350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 33.000000 1650.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 83 633.000000 9495.0000 15.0000
INTR-T1013-INTERPRETER 1 4.000000 150.0000 37.5000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 547 5106.000000 61992.0000 12.1410
OCCT-97530-OT SESSION BY LICENSED OT 100 556.750000 38629.5700 69.3841
OCCT-97530GO-OT SESSION BY LICENSED OT 1 4.000000 201.6000 50.4000
OCCT-97530GT-OT SESSION BY LICENSED OT 4 13.750000 989.4500 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 44 307.750000 17846.1900 57.9892
OCCT-97530HMGT-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 43 219.750000 15615.3200 71.0595
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 161 1285.500000 91453.6200 71.1425
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 10.000000 701.6100 70.1610
TRAV-TRAVS-Travel by mile 3 79.000000 35.2000 0.4456
Subtotal (Total Children Is Unduplicated) 599 8654.250000 258921.9600 29.9185
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Total 8806.750000 268650.9800 30.5051
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Number of Children (Unduplicated) With at Least One Service 611
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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 5324 8743.500000 266449.1200 266437.1200
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
61 62.250000 2151.8600 0.0000
Other 1 1.000000 50.0000 50.0000
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Total 5386 8806.750000 268650.9800 266487.1200