CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1318.2400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 56.000000 4534.8800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1295.6800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 84.000000 6802.3200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 64.000000 5182.7200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 16.000000 1295.6800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 54.000000 3235.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 958.7200 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 13 13.000000 755.4300 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 12.000000 697.3200 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 6.000000 348.6600 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 348.6600 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 181 409.000000 30112.0300 73.6235
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 3.500000 175.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 13.000000 650.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 52 29.000000 725.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 38.000000 1900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 22 58.000000 1450.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 7.000000 350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 50 27.000000 675.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 295 1099.000000 59346.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 26 69.500000 3753.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 328 1472.000000 22080.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 310 1222.000000 14664.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 70 304.499998 24761.9400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 82 378.499999 24647.9200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 49 217.750000 17707.4300 81.3200
PHY-97110HM-PT SESSION BY PT ASST 53 249.875297 16288.1600 65.1852
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 176 696.250000 56619.0500 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 14.000000 1138.4800 81.3200
Subtotal (Total Children Is Unduplicated) 654 5898.875294 246930.9800 41.8607
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Total 6307.875294 277043.0100 43.9202
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Number of Children (Unduplicated) With at Least One Service 755
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Center 55
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 3034 2989.751630 91025.7100 91025.7100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 161.9600 0.0000
T 759 746.766780 25785.4600 25785.4600
2534 2569.356884 160069.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6328 6307.875294 277043.0100 116811.1700