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
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
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 1.500000 55.8000 37.2000
Subtotal (Total Children Is Unduplicated) 3 1.500000 55.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 13.500000 1012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 825.0000 97.0588
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1500.0000 85.7143
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 21.000000 1165.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 37 95.000000 6910.9100 72.7464
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 287.8400 71.9600
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 13 47.000000 2350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 8.250000 412.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 45.000000 3414.2800 75.8729
OCCT-97530GT-OT SESSION BY LICENSED OT 3 18.500000 1331.2600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 7.000000 503.7200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 26 141.250000 12348.8700 87.4256
PHY-97110GT-PT SESSION BY LICENSED PT 9 11.250000 1313.6700 116.7707
PHY-97110TL-PT SESSION BY LICENSED PT 3 11.000000 959.6000 87.2364
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 155.750000 12043.6100 77.3265
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 14.000000 1271.5600 90.8257
Subtotal (Total Children Is Unduplicated) 87 465.000000 36358.8700 78.1911
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Total 561.500000 43325.5800 77.1604
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Number of Children (Unduplicated) With at Least One Service 113
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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 0 0.000000 0.0000 0.0000
P 49 46.250000 7820.8700 4451.8300
D 453 475.500000 33349.6900 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
42 39.750000 2155.0200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 544 561.500000 43325.5800 4451.8300