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:Program Patients
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 22 41.000000 2256.8400 55.0449
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 62 74.000000 5700.0000 77.0270
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 414.5000 63.7692
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 5.500000 409.4600 74.4473
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.500000 905.9800 72.4784
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 7 16.000000 745.5000 46.5938
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 51 70.000000 5250.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 25 31.000000 1600.4100 51.6261
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 411.2800 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 12 12.000000 623.6200 51.9683
Subtotal (Total Children Is Unduplicated) 153 285.000000 18798.0000 65.9579
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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 171 1159.000000 58071.9600 50.1052
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 35.000000 1754.0000 50.1143
EPIC-99601-Early Steps Professional Development Fee 86 637.000000 9555.0000 15.0000
INTR-T1013-INTERPRETER 2 6.000000 210.0000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 561 5154.000000 62568.0000 12.1397
OCCT-97530-OT SESSION BY LICENSED OT 158 733.500000 51674.6400 70.4494
OCCT-97530GO-OT SESSION BY LICENSED OT 1 4.000000 201.6000 50.4000
OCCT-97530GT-OT SESSION BY LICENSED OT 9 33.500000 2410.6600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 63 496.750000 28724.9900 57.8258
OCCT-97530HMGT-OT SESSION BY OT ASST 4 9.000000 518.4000 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 65 316.250000 22606.2600 71.4822
PHY-97110TL-PT SESSION BY LICENSED PT 1 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 246 1717.250000 123229.5500 71.7598
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 18.000000 1277.2900 70.9606
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
TRAV-TRAVS-Travel by mile 5 237.000000 105.5000 0.4451
Subtotal (Total Children Is Unduplicated) 620 10582.00000 364497.4500 34.4450
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Total 10867.000000 383295.4500 35.2715
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Number of Children (Unduplicated) With at Least One Service 652
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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 5420 9025.000000 271885.5900 271873.5900
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
1832 1841.000000 111359.8600 0.0000
Other 1 1.000000 50.0000 50.0000
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Total 7253 10867.000000 383295.4500 271923.5900