CMS/EIP Fiscal Report Center: 51
Services beginning 04/01/2025 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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 443.7600 68.2708
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.500000 988.6800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.000000 133.9700 66.9850
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 50.000000 3846.5500 76.9310
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.500000 1174.2100 71.1642
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 30.500000 2410.9200 79.0466
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.000000 295.9300 73.9825
OCTH-97165-OT EVAL LOW COMPLEXITY 24 24.000000 1394.6400 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 91 163.000000 11481.7200 70.4400
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.500000 225.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 151 830.500000 44827.4700 53.9765
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 31.000000 1674.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 76 429.000000 6435.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 420 2790.000000 33498.0000 12.0065
OCCT-97530-OT SESSION BY LICENSED OT 100 424.500000 32920.4200 77.5510
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 32 187.000000 12034.9700 64.3581
OCCT-97530HMGT-OT SESSION BY OT ASST 1 9.000000 586.0800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 70 304.000000 23878.1000 78.5464
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 121.9800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 151 769.000000 61933.1400 80.5372
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 14.000000 1138.4800 81.3200
Subtotal (Total Children Is Unduplicated) 485 5799.500000 219560.2800 37.8585
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Total 5962.500000 231042.0000 38.7492
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Number of Children (Unduplicated) With at Least One Service 520
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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 3338 4959.000000 164853.3100 164853.3100
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
1010 1002.500000 66176.6900 0.0000
Other 1 1.000000 12.0000 12.0000
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Total 4349 5962.500000 231042.0000 164865.3100