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
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 1291 6902.500000 256419.5500 37.1488
Subtotal (Total Children Is Unduplicated) 1291 6902.500000 256419.5500 37.1488
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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 14 27.500000 2062.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 24 42.000000 3150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 20.500000 1537.5000 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 9 16.000000 1200.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 33 62.500000 3468.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 60 111.000000 8325.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 213 374.000000 28050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 47.000000 3525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 184 337.500000 25275.0000 74.8889
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 37.500000 2812.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 101 177.000000 13275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 74.500000 4134.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 387 701.000000 38966.7500 55.5874
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 56.000000 4200.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 83.000000 6223.5000 74.9819
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) 638 2282.500000 152614.6000 66.8629
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 42.4100
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 565 5474.500000 273725.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 367 1391.000000 69537.5000 49.9910
OCCT-97530-OT SESSION BY LICENSED OT 68 555.000000 39915.8400 71.9204
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 35 89.500000 6440.4200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 95 676.500000 48680.9400 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 47 155.500000 11153.8000 71.7286
PHY-97110-PT SESSION BY LICENSED PT 6 44.750000 3220.2100 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.500000 323.8200 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 52 277.540000 19971.1000 71.9576
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 22 38.500000 2770.4600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 142 1135.130000 81682.7500 71.9589
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 64 194.230000 13976.4100 71.9580
Subtotal (Total Children Is Unduplicated) 962 11161.94000 652333.2700 58.4426
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Total 20346.940000 1061367.4200 52.1635
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Number of Children (Unduplicated) With at Least One Service 1364
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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 8 8.000000 455.5200 0.0000
P 14812 14012.610000 709832.9200 709623.7100
D 0 0.000000 0.0000 0.0000
S 6 6.200000 452.1000 0.0000
H 24 15.750000 585.9000 0.0000
T 0 0.000000 0.0000 0.0000
6004 6242.500000 345773.9200 0.0000
Other 71 61.880000 4267.0600 50.0000
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Total 20925 20346.940000 1061367.4200 709673.7100