CMS/EIP Fiscal Report Center: 51
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 11.000000 890.7800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 11 21.500000 1215.6600 56.5423
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 78.500000 6130.8100 78.0995
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.500000 595.3900 79.3853
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 11.500000 881.8100 76.6791
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 383.9700 69.8127
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 18.500000 929.6300 50.2503
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 3.000000 89.8800 29.9600
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 49.000000 3821.8000 77.9959
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 139.0900 69.5450
Subtotal (Total Children Is Unduplicated) 109 217.000000 15676.8700 72.2436
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 40.000000 2052.0000 51.3000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 15 17.000000 255.0000 15.0000
INTR-T1013-INTERPRETER 1 2.000000 60.0000 30.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 41 118.000000 1424.0000 12.0678
OCCT-97530HM-OT SESSION BY OT ASST 1 15.000000 976.8000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 13.000000 963.5600 74.1200
TRAV-TRAVS-Travel by mile 2 158.000000 70.3000 0.4449
Subtotal (Total Children Is Unduplicated) 55 364.000000 5851.6600 16.0760
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Total 581.000000 21528.5300 37.0543
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Number of Children (Unduplicated) With at Least One Service 121
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Center 51
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 257 485.500000 15156.0300 15156.0300
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 0 0.000000 0.0000 0.0000
85 95.500000 6372.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 342 581.000000 21528.5300 15156.0300