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: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 2.000000 111.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 359.5200 79.8933
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 15.500000 928.7600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 51.500000 4210.9600 81.7662
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 445.3900 74.2317
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 17.500000 767.6800 43.8674
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 28.000000 1769.9600 63.2129
OCTH-97165-OT EVAL LOW COMPLEXITY 24 24.000000 1387.9400 57.8308
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 464.8800 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 9 9.000000 522.9900 58.1100
Subtotal (Total Children Is Unduplicated) 90 180.000000 12034.1900 66.8566
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 28.000000 6426.2300 229.5082
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 8.500000 429.0000 50.4706
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 395.500000 21337.0000 53.9494
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 94 645.000000 9675.0000 15.0000
INTR-T1013-INTERPRETER 2 3.000000 120.0000 40.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 495 4398.000000 52988.0000 12.0482
OCCT-97530-OT SESSION BY LICENSED OT 77 469.750000 38018.3500 80.9332
OCCT-97530GO-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 5 11.000000 862.1200 78.3745
OCCT-97530HM-OT SESSION BY OT ASST 38 300.000000 19527.7400 65.0925
OCCT-97530HMGT-OT SESSION BY OT ASST 3 11.000000 716.3200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 49 236.000000 18917.1800 80.1575
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 133 979.750000 78920.1300 80.5513
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 4.500000 365.9400 81.3200
Subtotal (Total Children Is Unduplicated) 555 7500.000000 248963.6100 33.1951
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Total 7680.000000 260997.8000 33.9841
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Number of Children (Unduplicated) With at Least One Service 582
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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 5776 7668.000000 260354.1300 260354.1300
D 1 1.500000 121.4700 121.4700
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7 8.500000 428.8800 15.0000
Other 2 2.000000 93.3200 93.3200
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Total 5786 7680.000000 260997.8000 260583.9200