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
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.500000 605.7200 71.2612
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 11 20.000000 1198.4000 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 42 60.500000 4656.3500 76.9645
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 18.500000 1336.1700 72.2254
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 140.9000 70.4500
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 3.000000 89.8800 29.9600
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 44.000000 3476.1600 79.0036
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 5 6.000000 371.5300 61.9217
Subtotal (Total Children Is Unduplicated) 111 201.500000 14283.1400 70.8841
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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 77 430.000000 6450.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 429 2809.000000 33726.0000 12.0064
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 33 194.000000 12490.8100 64.3856
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) 495 5826.500000 220259.1200 37.8030
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Total 6028.000000 234542.2600 38.9088
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Number of Children (Unduplicated) With at Least One Service 542
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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 3382 5012.500000 167381.8100 167381.8100
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
1020 1014.500000 67148.4500 0.0000
Other 1 1.000000 12.0000 12.0000
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Total 4403 6028.000000 234542.2600 167393.8100