CMS/EIP Fiscal Report Center: 57
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:MED
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-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 5 8.500000 535.4800 62.9976
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 369 3683.000000 198882.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 34.000000 1836.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 21.500000 1748.3800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 65.1200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 7 27.500000 1790.8000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 6.750000 548.9100 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 25.500000 1660.5600 65.1200
Subtotal (Total Children Is Unduplicated) 386 3799.750000 206572.4300 54.3647
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Total 3808.250000 207107.9100 54.3840
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Number of Children (Unduplicated) With at Least One Service 387
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Center 57
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3818 3808.250000 207107.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3818 3808.250000 207107.9100 0.0000