CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2025 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 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 5.000000 298.7200 59.7440
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 14 19.500000 1217.7900 62.4508
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 227 1687.500000 91125.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 74.750000 4036.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 76.250000 6200.6500 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 30 246.750000 19980.6300 80.9752
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.750000 386.2700 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 339.750000 27396.3200 80.6367
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 6.000000 487.9200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 10.000000 651.2000 65.1200
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 6.000000 94.5600 15.7600
Subtotal (Total Children Is Unduplicated) 276 2457.750000 150846.9700 61.3760
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Total 2477.250000 152064.7600 61.3845
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Number of Children (Unduplicated) With at Least One Service 280
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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 1294 1289.000000 78741.8700 78741.8700
D 38 38.000000 2579.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1151 1148.750000 70654.5900 68544.2100
1 1.500000 89.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2484 2477.250000 152064.7600 147286.0800