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:MED
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.000000 242.9400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 12.500000 1012.2500 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 80.9800 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 15 18.500000 1475.2600 79.7438
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 308.000000 16632.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 29 92.500000 7522.1000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 9 38.000000 2474.5600 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 20 84.500000 6871.5400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 132.000000 10734.2400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 162 661.000000 44695.0400 67.6173
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Total 679.500000 46170.3000 67.9475
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Number of Children (Unduplicated) With at Least One Service 170
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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 0 0.000000 0.0000 0.0000
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
689 679.500000 46170.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 689 679.500000 46170.3000 0.0000