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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 991 3504.500000 130358.1000 37.1973
Subtotal (Total Children Is Unduplicated) 991 3504.500000 130358.1000 37.1973
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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 4 8.000000 600.0000 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 8 16.000000 888.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 112 209.500000 15712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 107 208.500000 15637.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 34 66.500000 4987.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 207 394.500000 21972.7500 55.6977
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) 237 935.000000 61773.6300 66.0681
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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 11015.500000 537301.8500 48.7769
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Number of Children (Unduplicated) With at Least One Service 1137
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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 3737 4105.750000 167162.3700 167032.1700
T 0 0.000000 0.0000 0.0000
6544 6635.750000 352116.2700 351816.2700
Other 133 260.500000 17343.7500 0.0000
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Total 10426 11015.500000 537301.8500 518894.9400