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
Payclass Filters:GR
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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 24.000000 1943.5200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 22.000000 1781.5600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 971.7600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 24.000000 1943.5200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1677.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 599.2000 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 5.569781 323.6600 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 290.5500 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 63 155.569781 11448.9200 73.5935
-----------------------------------------------------------------------------------------------------------------------
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 124 470.000000 25380.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 11 38.000000 2052.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 328 1470.000000 22050.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 310 1222.000000 14664.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 85.624694 6963.0000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 19 67.119317 4370.8100 65.1200
PHY-97110-PT SESSION BY LICENSED PT 17 56.025332 4555.9800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 11 56.073702 3651.5200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 192.416382 15647.3000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 8.000000 650.5600 81.3200
Subtotal (Total Children Is Unduplicated) 625 3840.759427 105910.1700 27.5753
-----------------------------------------------------------------------------------------------------------------------
Total 3996.329208 117359.0900 29.3667
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 655
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2863 2827.014417 79316.0600 79316.0600
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 688 672.266780 20309.7700 20309.7700
488 497.048011 17733.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4039 3996.329208 117359.0900 99625.8300