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:EIP DEI DEIP
Payclass Filters:TPIN
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 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 87.000000 7033.3000 80.8425
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 48 95.000000 7681.1400 80.8541
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 34.000000 2764.8800 81.3200
Subtotal (Total Children Is Unduplicated) 7 34.000000 2764.8800 81.3200
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Total 129.000000 10446.0200 80.9769
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Number of Children (Unduplicated) With at Least One Service 55
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 43 78.000000 6306.8600 0.0000
T 0 0.000000 0.0000 0.0000
39 51.000000 4139.1600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 82 129.000000 10446.0200 0.0000