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
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 3 6.000000 333.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.000000 485.8800 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 2 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 14 23.500000 1408.1200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 105.000000 8624.7100 82.1401
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 5 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.000000 404.9000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 30.000000 1332.9100 44.4303
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 68.000000 5049.6500 74.2596
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 80.9800 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 31 31.000000 1794.7100 57.8939
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
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 9 9.000000 522.9900 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 11 11.000000 639.2100 58.1100
Subtotal (Total Children Is Unduplicated) 168 318.000000 22362.2500 70.3215
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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 170 1184.000000 63916.0000 53.9831
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 3.000000 162.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 100 651.000000 9765.0000 15.0000
INTR-T1013-INTERPRETER 2 3.000000 120.0000 40.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 514 4437.000000 53464.0000 12.0496
OCCT-97530-OT SESSION BY LICENSED OT 141 716.750000 58104.3900 81.0665
OCCT-97530GO-OT SESSION BY LICENSED OT 4 7.000000 569.2400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 12.000000 943.4400 78.6200
OCCT-97530HM-OT SESSION BY OT ASST 52 471.000000 30663.2600 65.1025
OCCT-97530HMGT-OT SESSION BY OT ASST 4 12.000000 781.4400 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
OCCT-97530TLHM-OT SESSION BY OT ASST 1 9.000000 586.0800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 74 366.750000 29568.1100 80.6220
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 232 1368.750000 110553.6100 80.7698
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 4.500000 365.9400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 582 9292.250000 367105.6600 39.5066
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Total 9610.250000 389467.9100 40.5263
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Number of Children (Unduplicated) With at Least One Service 638
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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 5858 7769.750000 264985.8100 264985.8100
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
1836 1837.000000 124267.3100 15.0000
Other 2 2.000000 93.3200 93.3200
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Total 7697 9610.250000 389467.9100 265215.6000