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
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 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 14 16.000000 1385.5600 86.5975
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 8 10.000000 738.2400 73.8240
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 348.6600 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) 39 76.500000 5577.7500 72.9118
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 3.500000 175.0000 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 58 211.000000 11296.5000 53.5379
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 6.000000 378.0000 63.0000
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 63 217.750000 17488.8100 80.3160
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 26 95.000000 6197.9400 65.2415
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 40 116.500000 9270.4800 79.5749
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 455.000000 36620.7900 80.4853
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 8.000000 650.5600 81.3200
Subtotal (Total Children Is Unduplicated) 424 3279.250000 109777.2400 33.4763
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Total 3355.750000 115354.9900 34.3753
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Number of Children (Unduplicated) With at Least One Service 440
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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 2560 3352.750000 115318.9900 115318.9900
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
2 2.000000 24.0000 12.0000
Other 1 1.000000 12.0000 12.0000
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Total 2563 3355.750000 115354.9900 115342.9900