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:EIP DEI DEIP
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
EXIT-EXIT-COS Exit 2 2.000000 100.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 299.6000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.500000 607.3500 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 13 23.000000 1584.5500 68.8935
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 83.000000 4468.5000 53.8373
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 7.000000 378.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 46.500000 3781.3800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 6 33.000000 2683.5600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 9.000000 731.8800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 32.000000 2602.2400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 7.000000 569.2400 81.3200
Subtotal (Total Children Is Unduplicated) 37 229.500000 16046.6800 69.9202
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Total 252.500000 17631.2300 69.8267
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Number of Children (Unduplicated) With at Least One Service 46
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 2.000000 162.6400 0.0000
H 179 191.000000 13228.6800 0.0000
T 0 0.000000 0.0000 0.0000
58 59.500000 4239.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 239 252.500000 17631.2300 0.0000