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
Payclass Filters:GR
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 359.5200 79.8933
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 12 24.500000 1394.3600 56.9127
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.500000 40.4900 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 31.000000 2439.9200 78.7071
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 398.9200 79.7840
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 17.000000 1236.4200 72.7306
OCTH-97165-OT EVAL LOW COMPLEXITY 44 48.000000 2648.5800 55.1788
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
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
PSTH-97161-PT EVAL LOW COMPLEXITY 14 14.000000 759.9400 54.2814
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 18 18.000000 985.6800 54.7600
Subtotal (Total Children Is Unduplicated) 101 185.500000 11938.1300 64.3565
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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 24 30.250000 1491.5000 49.3058
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 78 1095.250000 57586.5000 52.5784
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 47.000000 2406.0000 51.1915
EPIC-99601-Early Steps Professional Development Fee 105 1950.000000 29250.0000 15.0000
INTR-T1013-INTERPRETER 2 5.000000 210.0000 42.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 592 13666.00000 164958.0000 12.0707
OCCT-97530-OT SESSION BY LICENSED OT 122 1614.250000 123030.2800 76.2151
OCCT-97530GO-OT SESSION BY LICENSED OT 4 10.000000 689.5200 68.9520
OCCT-97530GT-OT SESSION BY LICENSED OT 10 31.750000 2420.8100 76.2460
OCCT-97530HM-OT SESSION BY OT ASST 61 917.000000 57328.2300 62.5172
OCCT-97530HMGT-OT SESSION BY OT ASST 6 18.000000 1142.0800 63.4489
PHY-97110-PT SESSION BY LICENSED PT 55 743.500000 57441.5900 77.2584
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 121.9800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 191 3397.000000 260920.6500 76.8091
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 30.500000 2206.0300 72.3289
TRAV-TRAVS-Travel by mile 2 70.000000 31.1500 0.4450
Subtotal (Total Children Is Unduplicated) 641 23673.25000 769004.5900 32.4841
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Total 23858.750000 780942.7200 32.7319
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Number of Children (Unduplicated) With at Least One Service 646
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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 16373 23779.500000 777853.9800 777800.0900
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
73 75.250000 2933.4200 15.0000
Other 4 4.000000 155.3200 155.3200
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Total 16450 23858.750000 780942.7200 777970.4100