CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 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 1500 7898.000000 293433.5500 37.1529
Subtotal (Total Children Is Unduplicated) 1500 7898.000000 293433.5500 37.1529
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 21.500000 1612.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 18 31.500000 2362.5000 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 8 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 10 18.000000 1350.0000 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 29 53.500000 2969.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 103.000000 7725.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 218 375.000000 28125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 46.500000 3487.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 149 265.000000 19837.5000 74.8585
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 26 44.500000 3337.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 141 232.500000 17408.2500 74.8742
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 76.500000 4245.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 350 608.500000 33838.5000 55.6097
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 62.000000 4650.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 103.500000 7761.0000 74.9855
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 11.000000 565.5100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 8 80.000000 4112.8000 51.4100
Subtotal (Total Children Is Unduplicated) 738 2163.500000 145684.1000 67.3372
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 253 1884.000000 94200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 176 441.000000 22037.5000 49.9717
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 287.8400 71.9600
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 7.000000 503.7200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 73 553.500000 39829.8600 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 15.500000 1115.3800 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 4 17.000000 1223.3200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 42 147.500000 10578.1200 71.7161
PHY-97110-PT SESSION BY LICENSED PT 5 32.750000 2356.6900 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.500000 107.9400 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 81 1049.040000 75524.5800 71.9940
PHY-97110TLGT-PT SESSION BY LICENSED PT 27 40.750000 2932.3700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 17.440000 1254.5200 71.9335
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 9.500000 683.6200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 118 1013.130000 72903.9100 71.9591
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 62 191.000000 13744.3600 71.9600
Subtotal (Total Children Is Unduplicated) 534 5425.610000 339355.6900 62.5470
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Total 15487.110000 778473.3400 50.2659
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Number of Children (Unduplicated) With at Least One Service 1542
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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 11 12.000000 604.3200 0.0000
P 16128 15475.110000 777869.0200 777500.8100
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 16139 15487.110000 778473.3400 777500.8100