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
Payclass Filters:GR
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 18 23.000000 1911.9300 83.1274
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 9 11.000000 819.2200 74.4745
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) 49 92.500000 6750.3300 72.9765
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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 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 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) 430 3285.250000 109855.2400 33.4389
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Total 3377.750000 116605.5700 34.5217
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Number of Children (Unduplicated) With at Least One Service 454
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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 2577 3374.750000 116569.5700 116569.5700
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
2 2.000000 24.0000 12.0000
Other 1 1.000000 12.0000 12.0000
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Total 2580 3377.750000 116605.5700 116593.5700