CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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-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 4 7.000000 566.8600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 5.000000 404.9000 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 7.500000 509.3200 67.9093
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 569.2400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2429.4000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 25.000000 2024.5000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 850.2900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 19.500000 1579.1100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 728.8200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 43.500000 2606.5200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 48.000000 2876.1600 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 106.2200 53.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 84 233.500000 16445.0400 70.4284
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 10.000000 797.1100 79.7110
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 83 85.000000 4250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 22 20.750000 1037.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 50 73.500000 3650.0000 49.6599
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 8 12.750000 637.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 6.500000 162.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 12.250000 612.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 29 66.000000 3300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.500000 425.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 17.000000 850.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 22 21.750000 1087.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 162.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 133 604.000000 32616.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 19.000000 1026.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 438 2330.000000 34938.0000 14.9948
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 193 723.000000 8676.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 84.000000 6720.8800 80.0105
OCCT-97530GT-OT SESSION BY LICENSED OT 1 8.000000 650.5600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 29 39.250000 3024.1900 77.0494
PHY-97110GT-PT SESSION BY LICENSED PT 1 7.000000 569.2400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 23.000000 1827.0500 79.4370
TRAV-TRAVS-Travel by mile 470 42138.00000 18746.1500 0.4449
Subtotal (Total Children Is Unduplicated) 587 46320.25000 125940.6800 2.7189
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Total 46553.750000 142385.7200 3.0585
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Number of Children (Unduplicated) With at Least One Service 600
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Center 05
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 5845 39807.750000 121137.7600 121137.7600
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
989 6746.000000 21247.9600 21247.9600
Other 0 0.000000 0.0000 0.0000
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Total 6834 46553.750000 142385.7200 142385.7200