CMS/EIP Fiscal Report Center: 54
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 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 311.9600 77.9900
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 14.000000 1121.7600 80.1257
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 26 50.500000 3017.1200 59.7450
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 30.500000 1761.2600 57.7462
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1223.9200 76.4950
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 623.9200 77.9900
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 21.500000 1672.3000 77.7814
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 99.000000 5715.5000 57.7323
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 67 130.500000 7463.7500 57.1935
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 30.000000 2417.4400 80.5813
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1817.6900 79.0300
Subtotal (Total Children Is Unduplicated) 201 444.500000 28551.8100 64.2335
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 132.000000 3475.0000 26.3258
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 454 6375.250000 336690.5000 52.8121
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 224 706.250000 37329.5000 52.8559
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 28 256.000000 19910.0000 77.7734
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 5 5.000000 378.5200 75.7040
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 377.000000 29805.8800 79.0607
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 47.500000 3778.4600 79.5465
Subtotal (Total Children Is Unduplicated) 520 7902.000000 431611.8200 54.6206
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Total 8346.500000 460163.6300 55.1325
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Number of Children (Unduplicated) With at Least One Service 611
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Center 54
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
8165 8346.500000 460163.6300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8165 8346.500000 460163.6300 0.0000