CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 679 2117.250000 78743.1000 37.1912
Subtotal (Total Children Is Unduplicated) 679 2117.250000 78743.1000 37.1912
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 11.500000 862.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 8.500000 471.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.500000 2362.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 54 94.000000 7050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 31 52.500000 3937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 37 61.000000 4575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 25.000000 1387.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 100 173.500000 9629.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.500000 1987.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1462.5000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 7.000000 359.8700 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 13.000000 668.3300 51.4100
Subtotal (Total Children Is Unduplicated) 193 569.500000 38165.2000 67.0153
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 121 487.500000 24375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 59 106.750000 5337.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 40 192.000000 13816.3200 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 2 12.000000 863.5200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 17 51.250000 3687.9500 71.9600
PHY-97110-PT SESSION BY LICENSED PT 2 7.000000 503.7200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 40 256.250000 18475.7300 72.1004
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 3.250000 233.8700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 863.5200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 67 300.000000 21588.0000 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 20 42.500000 3058.3000 71.9600
Subtotal (Total Children Is Unduplicated) 284 1471.500000 92875.3900 63.1161
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Total 4158.250000 209783.6900 50.4500
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Number of Children (Unduplicated) With at Least One Service 739
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Center 53
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 5 4.000000 224.4000 0.0000
P 4319 4154.250000 209559.2900 209473.3900
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4324 4158.250000 209783.6900 209473.3900