CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
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 6 7.500000 602.4600 80.3280
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 18.000000 1078.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 20.000000 1709.4800 85.4740
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 22.500000 1750.4900 77.7996
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 80.9800 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 406.7700 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 54 96.000000 7133.9900 74.3124
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 4.500000 225.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 142 522.000000 28090.5000 53.8132
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 7.000000 432.0000 61.7143
EPIC-99601-Early Steps Professional Development Fee 70 371.000000 5565.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 370 1786.000000 21441.0000 12.0050
OCCT-97530-OT SESSION BY LICENSED OT 92 310.250000 25010.9100 80.6153
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 35 133.000000 8672.5000 65.2068
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 60 201.000000 16142.0200 80.3086
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 160 587.000000 47355.0300 80.6730
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 8.000000 650.5600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 428 3944.250000 154684.2800 39.2177
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Total 4040.250000 161818.2700 40.0515
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Number of Children (Unduplicated) With at Least One Service 451
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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 2563 3355.750000 115480.9900 115480.9900
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
693 683.500000 46325.2800 12.0000
Other 1 1.000000 12.0000 12.0000
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Total 3257 4040.250000 161818.2700 115504.9900