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:MED
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 24.500000 1926.8800 78.6482
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.500000 114.5000 45.8000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 48.500000 3755.7300 77.4377
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 3.500000 277.4500 79.2714
OCTH-97165-OT EVAL LOW COMPLEXITY 14 19.000000 1037.0900 54.5837
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 68 107.000000 7671.3200 71.6946
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 145 2149.500000 113226.9600 52.6760
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 10.000000 540.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 76 600.000000 47519.9200 79.1999
OCCT-97530GO-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 21.750000 1583.8500 72.8207
OCCT-97530HM-OT SESSION BY OT ASST 21 489.000000 30414.8000 62.1980
OCCT-97530HMGT-OT SESSION BY OT ASST 4 6.000000 353.1200 58.8533
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 26 336.000000 26658.9600 79.3421
PHY-97110TL-PT SESSION BY LICENSED PT 1 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 110 1032.750000 80864.5300 78.3002
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 10.000000 738.3200 73.8320
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 6.000000 459.8400 76.6400
Subtotal (Total Children Is Unduplicated) 294 4730.000000 307042.0600 64.9138
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Total 4837.000000 314713.3800 65.0638
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Number of Children (Unduplicated) With at Least One Service 315
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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 0 0.000000 0.0000 0.0000
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
4876 4837.000000 314713.3800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4876 4837.000000 314713.3800 0.0000