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
Payclass Filters:GR
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-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 311.8800 56.7055
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.500000 995.9300 73.7726
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 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 10.000000 739.4100 73.9410
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 80.9800 80.9800
Subtotal (Total Children Is Unduplicated) 17 33.000000 2314.2000 70.1273
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 5 5.000000 75.0000 15.0000
INTR-T1013-INTERPRETER 1 2.000000 60.0000 30.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 62.000000 744.0000 12.0000
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) 16 240.000000 1912.8600 7.9703
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Total 273.000000 4227.0600 15.4837
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Number of Children (Unduplicated) With at Least One Service 29
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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 95 271.000000 4167.0600 4167.0600
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
1 2.000000 60.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 96 273.000000 4227.0600 4167.0600