CMS/EIP Fiscal Report Center: 54
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
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 539.2800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 40.000000 2396.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 20 39.000000 2336.8800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 809.8000 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 58 124.000000 8104.0000 65.3548
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 20.000000 540.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 297 1149.000000 62046.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 73 114.750000 6196.5000 54.0000
PHY-97110-PT SESSION BY LICENSED PT 10 29.000000 2358.2800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 55.000000 4472.6000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 6.500000 528.5800 81.3200
Subtotal (Total Children Is Unduplicated) 343 1374.250000 76141.9600 55.4062
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Total 1498.250000 84245.9600 56.2296
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Number of Children (Unduplicated) With at Least One Service 384
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Center 54
Flag Claims Units Chgs Paid
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R 2 1.500000 121.9800 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
1440 1496.750000 84123.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1442 1498.250000 84245.9600 0.0000