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: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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 5.430219 315.5500 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 39 72.430219 5401.7800 74.5791
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 16.000000 864.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 75.375304 6129.5200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 23 97.630682 6357.7100 65.1200
PHY-97110-PT SESSION BY LICENSED PT 15 56.724668 4612.8500 81.3200
PHY-97110HM-PT SESSION BY PT ASST 20 86.051595 5603.6800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 205.833618 16738.3900 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
Subtotal (Total Children Is Unduplicated) 115 542.615867 40685.4300 74.9802
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Total 615.046086 46087.2100 74.9329
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Number of Children (Unduplicated) With at Least One Service 138
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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 171 162.737213 11709.6500 11709.6500
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 71 74.500000 5475.6900 5475.6900
405 375.808873 28739.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 648 615.046086 46087.2100 17185.3400