CMS/EIP Fiscal Report Center: 55
Services beginning 07/01/2024 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 26.000000 2045.6800 78.6800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 16.000000 1235.8800 77.2425
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 635.8800 79.4850
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 30 60.000000 4751.1600 79.1860
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 461.9600 76.9933
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 41 78.500000 4633.0000 59.0191
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 16.000000 941.0400 58.8150
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 141 285.000000 22553.0600 79.1335
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 30 60.000000 4775.0800 79.5847
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 148 295.999999 23465.6000 79.2757
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 30 59.000000 4694.1000 79.5610
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 207 414.000000 32939.6800 79.5644
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 56.000000 4427.2400 79.0579
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 338.000000 19917.0400 58.9262
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 31 62.000000 3635.4800 58.6368
OCTF-97168-OT RE-EVAL EST PLAN CARE 80 93.001720 5297.1300 56.9573
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 14 15.000000 844.8500 56.3233
OCTH-97167-OT EVAL HIGH COMPLEXITY 89 90.000000 5080.3100 56.4479
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 43 49.000000 2773.6900 56.6059
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 26 27.000000 1508.6700 55.8767
PSTH-97163-PT EVAL HIGH COMPLEXITY 15 15.000000 844.8500 56.3233
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 57 59.750000 3311.2725 55.4188
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 879 2142.251719 151658.6025 70.7940
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 242.8000 121.4000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 33.250000 1662.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 3 2.500000 125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 174 277.000000 13850.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 23 25.000000 1250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 137 270.000000 6750.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 74 213.500000 10450.0000 48.9461
CONOP-CONOP-CONSULT, OT, PHONE 49 278.000000 6950.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 148 250.500000 12500.0000 49.9002
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 19 21.000000 1050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 130 263.500000 6587.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 599 9713.500000 514273.0000 52.9441
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 59 324.250000 17333.5000 53.4572
EPIC-99601-Early Steps Professional Development Fee 700 10275.00000 154125.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 750 11097.00000 133229.9600 12.0059
OCCT-97530-OT SESSION BY LICENSED OT 158 2065.750005 162345.3000 78.5890
OCCT-97530GT-OT SESSION BY LICENSED OT 2 8.000000 650.5600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 193 3225.319835 203555.4800 63.1117
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
OCCT-97530TLHM-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 96 1484.875085 112942.4500 76.0619
PHY-97110HM-PT SESSION BY PT ASST 89 1535.103548 96537.0492 62.8863
PHY-97110HMGT-PT SESSION BY PT ASST 2 4.750000 309.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 392 5524.887638 433424.4800 78.4495
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 15 80.500000 6536.9000 81.2037
TRAV-TRAVS-Travel by mile 1 70.000000 31.1500 0.4450
Subtotal (Total Children Is Unduplicated) 1278 47052.93611 1897018.5392 40.3167
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Total 49195.187830 2048677.1417 41.6439
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Number of Children (Unduplicated) With at Least One Service 1503
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Center 55
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 32459 32002.897376 1021838.6925 1021854.5900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 8.000000 647.8400 0.0000
T 2263 2174.652618 65753.4900 65753.4900
15037 15009.637836 960437.1192 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 49763 49195.187830 2048677.1417 1087608.0800