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
Agency Filter:EIP DEI DEIP
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 6898.500000 256270.7500 37.1488
Subtotal (Total Children Is Unduplicated) 1291 6898.500000 256270.7500 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 9 19.500000 1462.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 17 29.500000 2212.5000 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 7 12.500000 937.5000 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 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 22 38.500000 2136.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 85.500000 6412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 159 281.000000 21075.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 35.000000 2625.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 120 216.500000 16200.0000 74.8268
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 98 167.000000 12525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 61.000000 3385.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 267 473.500000 26346.0000 55.6410
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) 560 1720.000000 115678.1000 67.2547
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 42.4100
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 253 1885.000000 94250.0000 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 73 554.500000 39901.8200 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 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 12 27.540000 1981.1000 71.9354
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 11.500000 827.5400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 120 1040.130000 74846.5500 71.9588
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 64 194.230000 13976.4100 71.9580
Subtotal (Total Children Is Unduplicated) 537 5485.940000 343644.6500 62.6410
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Total 14104.440000 715593.5000 50.7353
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Number of Children (Unduplicated) With at Least One Service 1329
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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
0 0.000000 0.0000 0.0000
Other 71 61.880000 4267.0600 50.0000
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Total 14921 14104.440000 715593.5000 709673.7100