CMS/EIP Fiscal Report Center: 55
Services beginning 04/01/2025 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 3 6.000000 485.8800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 971.7600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 46.000000 3725.0800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 52.000000 4210.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 92.000000 7450.1600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 4194.4000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 838.8800 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 21 21.000000 1220.3100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 18 18.000000 1045.9800 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 406.7700 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 639.2100 58.1100
Subtotal (Total Children Is Unduplicated) 175 392.000000 28392.3200 72.4294
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 38.500000 1925.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 57 47.500000 1187.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 24 44.000000 2200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 28 52.000000 1300.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 33.500000 1675.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 56 46.500000 1162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 333 1977.750000 106798.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 67.000000 3618.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 421 2371.000000 35565.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 308 1799.000000 21588.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 74 360.000000 29275.2000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 103 632.250000 41172.1200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 52 307.000000 24965.2400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 58 311.249986 20268.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 188 921.250000 74916.0500 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 29.500000 2398.9400 81.3200
Subtotal (Total Children Is Unduplicated) 726 9042.999986 370303.2900 40.9492
-----------------------------------------------------------------------------------------------------------------------
Total 9434.999986 398695.6100 42.2571
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 796
-----------------------------------------------------------------------------------------------------------------------
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 4024 3959.465722 123126.9800 123126.9800
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 2173 2098.592728 62354.2600 62354.2600
3354 3376.941536 213214.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9551 9434.999986 398695.6100 185481.2400