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
Eligibility Filter:Program Patients
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 4 8.500000 445.5000 52.4118
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 36.500000 2913.6500 79.8260
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 15.000000 1204.9200 80.3280
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 60 113.500000 6562.2400 57.8171
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 239 316.500000 25295.1700 79.9215
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 25.000000 1863.1700 74.5268
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 64.500000 4984.8300 77.2842
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 12 18.500000 1391.8600 75.2357
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 16 49.000000 2279.2300 46.5149
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 256.3800 42.7300
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 178 238.000000 18183.6900 76.4021
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 7.000000 532.8900 76.1271
OCTH-97165-OT EVAL LOW COMPLEXITY 104 113.000000 6352.0300 56.2127
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 36 37.000000 2099.2400 56.7362
Subtotal (Total Children Is Unduplicated) 552 1092.000000 77070.8300 70.5777
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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 305 4260.250000 225381.4300 52.9033
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 97.000000 5156.0000 53.1546
EPIC-99601-Early Steps Professional Development Fee 171 2345.000000 35175.0000 15.0000
INTR-T1013-INTERPRETER 4 9.000000 330.0000 36.6667
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 891 16581.00000 199930.0000 12.0578
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 96 1488.500000 93140.9800 62.5737
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 369 5121.250000 397023.7300 77.5248
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 5 237.000000 105.5000 0.4451
Subtotal (Total Children Is Unduplicated) 984 34438.00000 1288766.3100 37.4228
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Total 35530.000000 1365837.1400 38.4418
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Number of Children (Unduplicated) With at Least One Service 1123
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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 20205 29451.000000 970073.7300 970061.7300
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
6082 6072.500000 395474.6200 15.0000
Other 5 5.000000 167.3200 167.3200
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Total 26293 35530.000000 1365837.1400 970365.5200