CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 934 3325.000000 123680.7000 37.1972
Subtotal (Total Children Is Unduplicated) 934 3325.000000 123680.7000 37.1972
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 88 166.500000 12487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 86 169.000000 12675.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 25 50.000000 3750.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 166 320.500000 17865.7500 55.7434
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 17.000000 873.9700 51.4100
Subtotal (Total Children Is Unduplicated) 189 756.000000 49830.6300 65.9135
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 723 5766.000000 288065.0000 49.9592
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 45.000000 2250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 28 150.000000 10794.0000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 12.000000 691.2000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 5 11.000000 791.5600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 25 245.000000 17630.2000 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 331.000000 23796.8000 71.8937
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 6.000000 431.7600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 6.000000 431.7600 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 754 6576.000000 345170.1200 52.4894
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Total 10657.000000 518681.4500 48.6705
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Number of Children (Unduplicated) With at Least One Service 1080
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Center 09
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 2 3.500000 157.5000 46.5000
D 10 10.000000 521.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 3558 3830.250000 154415.9700 154285.7700
T 0 0.000000 0.0000 0.0000
6526 6600.750000 349569.2700 349269.2700
Other 108 212.500000 14016.7500 0.0000
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Total 10204 10657.000000 518681.4500 503601.5400