CMS/EIP Fiscal Report Center: 51
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Payclass Filters:GR
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-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
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 23.500000 1903.0300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 12.500000 565.2300 45.2184
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.000000 607.3500 86.7643
Subtotal (Total Children Is Unduplicated) 23 51.000000 3579.4100 70.1845
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 6 6.000000 90.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 19 39.000000 476.0000 12.2051
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 22 48.000000 809.9600 16.8742
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Total 99.000000 4389.3700 44.3371
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Number of Children (Unduplicated) With at Least One Service 36
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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 77 98.000000 4308.3900 4308.3900
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
1 1.000000 80.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 78 99.000000 4389.3700 4308.3900