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:TPIN
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-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 719.0400 59.9200
Subtotal (Total Children Is Unduplicated) 15 31.500000 2055.9600 65.2686
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 160.2900 80.1450
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 66 231.500000 12501.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 41.000000 2214.0000 54.0000
PHY-97110-PT SESSION BY LICENSED PT 7 19.000000 1545.0800 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.000000 325.2800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 66.000000 5367.1200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 325.2800 81.3200
Subtotal (Total Children Is Unduplicated) 103 367.500000 22438.0500 61.0559
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Total 399.000000 24494.0100 61.3885
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Number of Children (Unduplicated) With at Least One Service 114
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Center 54
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 110 110.830000 6807.3900 6807.3900
289 288.170000 17686.6200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 399 399.000000 24494.0100 6807.3900