CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-COS Exit 14 12.000000 600.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 650.2800 59.1164
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSTL-F/U PSYCH 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 302.9600 75.7400
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1145.9300 76.3953
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 79.000000 4435.3300 56.1434
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2122.3600 56.5963
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 22.500000 1675.4100 74.4627
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1286.9600 75.7035
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 290.5500 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 160.9300 53.6433
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 277.1500 55.4300
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 502.8900 55.8767
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 55.000000 4121.3900 74.9344
Subtotal (Total Children Is Unduplicated) 147 295.000000 18819.0300 63.7933
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 576 9065.000000 477267.0000 52.6494
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 125 831.500000 43655.0000 52.5015
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
INTR-T1013-INTERPRETER 2 2.500000 125.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 4.000000 48.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 417.250000 33011.7300 79.1174
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 8 34.000000 2615.1200 76.9153
PHY-97110-PT SESSION BY LICENSED PT 65 1166.250000 90937.8500 77.9746
PHY-97110GT-PT SESSION BY LICENSED PT 13 34.250000 2629.9500 76.7869
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 114 1836.750000 143202.4300 77.9651
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 115.000000 8907.2000 77.4539
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 22.000000 1432.6400 65.1200
SPL-92508HA-GROUP SPL SESSION PER CHILD 3 19.000000 292.2400 15.3811
Subtotal (Total Children Is Unduplicated) 681 13559.50000 804719.1200 59.3473
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Total 13854.500000 823538.1500 59.4419
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Number of Children (Unduplicated) With at Least One Service 715
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Center 01
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 12440 12470.000000 737406.8400 737268.8400
D 214 213.250000 14204.3600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1168 1165.750000 71617.3100 69506.9300
5 5.500000 309.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13827 13854.500000 823538.1500 806775.7700