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
Agency Filter:EXT
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 1 1.000000 50.0000 50.0000
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.500000 223.5000 49.6667
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 25.500000 2022.8700 79.3282
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 14.000000 1123.9400 80.2814
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 49 92.000000 5346.5800 58.1150
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.000000 214.9500 71.6500
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 184 238.000000 19164.3600 80.5225
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 17.500000 1267.7800 72.4446
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 53.000000 4103.0200 77.4155
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 13.000000 1007.8900 77.5300
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 28.500000 1238.6000 43.4596
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 140 189.000000 14361.8900 75.9888
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 7.000000 532.8900 76.1271
OCTH-97165-OT EVAL LOW COMPLEXITY 103 112.000000 6293.9200 56.1957
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 109.5200 54.7600
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 25 25.000000 1399.1500 55.9660
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 34 35.000000 1960.1500 56.0043
Subtotal (Total Children Is Unduplicated) 440 872.000000 61227.4600 70.2150
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 31.000000 7120.2700 229.6861
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 31.250000 1541.5000 49.3280
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 3.750000 187.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 3.500000 162.5000 46.4286
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 3.000000 150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 5.000000 150.0000 30.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 302 4220.250000 223329.4300 52.9185
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 17 96.000000 5106.0000 53.1875
EPIC-99601-Early Steps Professional Development Fee 156 2328.000000 34920.0000 15.0000
INTR-T1013-INTERPRETER 3 7.000000 270.0000 38.5714
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 850 16463.00000 198506.0000 12.0577
OCCT-97530-OT SESSION BY LICENSED OT 245 2610.750000 200413.5000 76.7647
OCCT-97530GO-OT SESSION BY LICENSED OT 6 13.000000 933.4800 71.8062
OCCT-97530GT-OT SESSION BY LICENSED OT 16 53.500000 4004.6600 74.8535
OCCT-97530HM-OT SESSION BY OT ASST 95 1473.500000 92164.1800 62.5478
OCCT-97530HMGT-OT SESSION BY OT ASST 11 33.000000 2081.2800 63.0691
OCCT-97530TL-OT SESSION BY LICENSED OT 1 8.000000 650.5600 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 9 51.000000 3283.5200 64.3827
PHY-97110-PT SESSION BY LICENSED PT 118 1386.250000 106920.4900 77.1293
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 121.9800 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 1 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 368 5108.250000 396060.1700 77.5334
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 51.500000 3838.8700 74.5412
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 6.000000 459.8400 76.6400
TRAV-TRAVS-Travel by mile 3 79.000000 35.2000 0.4456
Subtotal (Total Children Is Unduplicated) 929 34074.00000 1282914.6500 37.6508
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Total 34946.000000 1344142.1100 38.4634
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Number of Children (Unduplicated) With at Least One Service 1001
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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 19948 28965.500000 954917.7000 954905.7000
D 1 1.500000 121.4700 121.4700
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5994 5974.000000 388935.6200 15.0000
Other 5 5.000000 167.3200 167.3200
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Total 25948 34946.000000 1344142.1100 955209.4900