CMS/EIP Fiscal Report Center: 54
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
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-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 8.000000 479.3600 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 11 23.500000 1650.3100 70.2260
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 5.000000 212.6100 42.5220
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 25.500000 1275.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 65 67.250000 3362.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 23.500000 1175.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 12 12.750000 637.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 6.500000 162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 66 339.000000 18306.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 21 44.500000 2403.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 231 1403.000000 21045.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 181 896.000000 10752.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 9 34.000000 2764.8800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 25.000000 2033.0000 81.3200
TRAV-TRAVS-Travel by mile 382 31865.00000 14175.4100 0.4449
Subtotal (Total Children Is Unduplicated) 405 34747.00000 78304.4000 2.2536
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Total 34770.500000 79954.7100 2.2995
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Number of Children (Unduplicated) With at Least One Service 407
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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 3 3.000000 124.6300 0.0000
H 0 0.000000 0.0000 0.0000
T 2680 19597.500000 42391.0300 42391.0300
2289 15170.000000 37439.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4972 34770.500000 79954.7100 42391.0300