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:Program Patients
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 7 9.000000 728.8200 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 8.500000 683.4400 80.4047
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 10 20.000000 1198.4000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 28.000000 2316.8300 82.7439
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 4 8.000000 607.3500 75.9188
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 25.500000 1993.4300 78.1737
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 5 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 68 116.000000 8607.6200 74.2036
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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 143 523.000000 28144.5000 53.8136
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 7.000000 432.0000 61.7143
EPIC-99601-Early Steps Professional Development Fee 72 373.000000 5595.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 374 1790.000000 21489.0000 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) 434 3951.250000 154816.2800 39.1816
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Total 4067.250000 163423.9000 40.1804
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Number of Children (Unduplicated) With at Least One Service 466
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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 2580 3377.750000 116731.5700 116731.5700
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
698 688.500000 46680.3300 12.0000
Other 1 1.000000 12.0000 12.0000
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Total 3279 4067.250000 163423.9000 116755.5700