CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Agency Filter:EXT
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 14.000000 1133.7200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1348.2000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 37 76.000000 6154.4800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 57.999999 4696.8400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 971.7600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 128.000000 10365.4400 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1133.7200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 102.000000 6111.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 29 29.001721 1685.2900 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 813.5400 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 17 17.000000 987.8700 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 11 11.000000 639.2100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 16.000000 929.7600 58.1100
Subtotal (Total Children Is Unduplicated) 260 550.501720 39555.1200 71.8529
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 242.8000 121.4000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 9.500000 475.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 87 87.000000 4350.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 82 74.500000 1862.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 29 57.000000 2850.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 27 91.000000 2275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 82 82.000000 4100.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 4 4.000000 200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 84 76.500000 1912.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 346 2445.750000 132070.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 27 81.750000 4414.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 336 2445.000000 36675.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 404 2805.000000 33660.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 90 535.750000 43567.1900 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 90 771.499998 50174.9600 65.0356
OCCT-97530TLHM-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 58 332.249998 27018.5700 81.3200
PHY-97110HM-PT SESSION BY PT ASST 45 335.359627 21854.9000 65.1685
PHY-97110HMGT-PT SESSION BY PT ASST 2 4.750000 309.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 212 1456.462979 118439.5700 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 20.000000 1626.4000 81.3200
Subtotal (Total Children Is Unduplicated) 729 11726.07260 488533.9500 41.6622
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Total 12276.574322 528089.0700 43.0160
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Number of Children (Unduplicated) With at Least One Service 820
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Center 55
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 8647 8466.020635 275061.5900 275077.4900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 323.9200 0.0000
T 18 17.125183 1131.0400 1131.0400
3831 3789.428504 251572.5200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 12498 12276.574322 528089.0700 276208.5300