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:EIP DEI DEIP
Payclass Filters:TPIN
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 20 39.000000 3098.4200 79.4467
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 10.000000 785.8800 78.5880
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 66.000000 5093.5200 77.1745
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 923.9200 76.9933
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 109.5200 54.7600
Subtotal (Total Children Is Unduplicated) 66 133.000000 10335.1800 77.7081
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 151.115622 11885.1600 78.6494
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 9 152.115622 11957.1200 78.6055
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Total 285.115622 22292.3000 78.1869
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Number of Children (Unduplicated) With at Least One Service 73
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 49 77.000000 6036.6000 0.0000
T 0 0.000000 0.0000 0.0000
173 208.115622 16255.7000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 222 285.115622 22292.3000 0.0000