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
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 4.750000 176.7000 37.2000
Subtotal (Total Children Is Unduplicated) 3 4.750000 176.7000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 40 80.000000 6000.0000 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 62 123.500000 9262.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2250.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 112.000000 6255.0000 55.8482
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) 153 379.500000 25775.8800 67.9206
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 697 5641.000000 281815.0000 49.9583
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 42.000000 2100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 146.000000 10506.1600 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
Subtotal (Total Children Is Unduplicated) 731 6441.000000 338266.4000 52.5177
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Total 6825.250000 364218.9800 53.3635
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Number of Children (Unduplicated) With at Least One Service 800
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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 1 2.000000 111.0000 0.0000
D 10 10.000000 521.9600 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
6526 6600.750000 349569.2700 349269.2700
Other 108 212.500000 14016.7500 0.0000
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Total 6645 6825.250000 364218.9800 349269.2700