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
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 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 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 12 26.000000 1929.7600 74.2215
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 13.000000 650.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 29 24.500000 612.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 21.000000 1050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 14 30.000000 750.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 10.000000 500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 29 24.500000 612.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 60 316.750000 17104.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 8.500000 459.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 230 1370.000000 20550.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 152 923.000000 11076.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 63.534804 5166.6500 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 13 65.805896 4285.2800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 11 48.713232 3961.3600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 15 67.193788 4375.6600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 128.923757 10484.0800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
Subtotal (Total Children Is Unduplicated) 343 3119.421477 81962.8100 26.2750
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Total 3145.421477 83892.5700 26.6713
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Number of Children (Unduplicated) With at Least One Service 346
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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 2065 2014.968474 53584.0200 53584.0200
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 1034 992.739771 26773.1500 26773.1500
139 137.713232 3535.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3238 3145.421477 83892.5700 80357.1700