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
Payclass Filters:GR
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-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 89.8800 59.9200
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 2 3.000000 202.4500 67.4833
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.000000 295.9300 73.9825
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 197.2000 65.7333
Subtotal (Total Children Is Unduplicated) 11 18.000000 1166.5000 64.8056
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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 30 139.500000 7527.0000 53.9570
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 324.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 44 281.000000 4215.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 216 1522.000000 18282.0000 12.0118
OCCT-97530-OT SESSION BY LICENSED OT 46 196.500000 15455.7300 78.6551
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 16 87.000000 5522.9700 63.4824
PHY-97110-PT SESSION BY LICENSED PT 31 108.750000 8671.2600 79.7357
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 121.9800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 76 370.250000 29905.4300 80.7709
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 251 2724.500000 90700.6500 33.2908
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Total 2742.500000 91867.1500 33.4976
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Number of Children (Unduplicated) With at Least One Service 254
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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 1933 2739.500000 91763.1500 91763.1500
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
2 3.000000 104.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1935 2742.500000 91867.1500 91763.1500