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: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
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 2 2.000000 106.9100 53.4550
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 4.000000 200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 7.000000 513.0800 73.2971
PHY-97110-PT SESSION BY LICENSED PT 6 32.000000 2438.0600 76.1894
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 13.000000 982.2800 75.5600
Subtotal (Total Children Is Unduplicated) 10 57.000000 4183.4200 73.3933
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Total 59.000000 4290.3300 72.7175
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Number of Children (Unduplicated) With at Least One Service 11
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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 24 21.000000 1491.3100 1491.3100
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
38 38.000000 2799.0200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 62 59.000000 4290.3300 1491.3100