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: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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 16.500000 1237.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 2.0000 2.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 39.000000 2962.5000 75.9615
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 7 11.000000 572.2100 52.0191
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 47 73.500000 5153.5700 70.1166
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 743.000000 37271.9600 50.1641
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 58 170.750000 12613.3100 73.8700
OCCT-97530GT-OT SESSION BY LICENSED OT 5 19.750000 1421.2100 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 19 189.000000 10878.8000 57.5598
OCCT-97530HMGT-OT SESSION BY OT ASST 3 5.000000 288.0000 57.6000
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 2 5.000000 288.0000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 18 77.000000 5587.7200 72.5678
PHY-97110TL-PT SESSION BY LICENSED PT 1 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 89 413.750000 30480.6500 73.6692
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 8.000000 575.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 245 1642.250000 100178.9300 61.0010
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Total 1715.750000 105332.5000 61.3915
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Number of Children (Unduplicated) With at Least One Service 270
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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 0 0.000000 0.0000 0.0000
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
1710 1715.750000 105332.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1710 1715.750000 105332.5000 0.0000