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: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 18 28.000000 1041.6000 37.2000
Subtotal (Total Children Is Unduplicated) 18 28.000000 1041.6000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 38.500000 3036.0000 78.8571
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 37 66.000000 5100.0000 77.2727
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.500000 1800.0000 92.3077
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 22 40.500000 3037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 21.000000 1575.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 41 72.000000 5775.0000 80.2083
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 28.000000 1554.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 70 124.500000 6898.7500 55.4116
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 0.580000 30.0000 51.7241
Subtotal (Total Children Is Unduplicated) 158 436.580000 30625.4100 70.1484
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 287.8400 71.9600
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 1.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 177.000000 8850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 47.750000 2374.7000 49.7319
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 215.500000 17004.0600 78.9052
OCCT-97530GT-OT SESSION BY LICENSED OT 12 66.000000 5805.8400 87.9673
OCCT-97530TL-OT SESSION BY LICENSED OT 2 8.000000 575.6800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 3.500000 251.8600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 47 601.350000 63487.7000 105.5753
PHY-97110GT-PT SESSION BY LICENSED PT 18 21.250000 2033.2700 95.6833
PHY-97110TL-PT SESSION BY LICENSED PT 3 16.000000 1655.4800 103.4675
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 645.880000 48732.7500 75.4517
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 35 90.770000 7870.7800 86.7112
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 5.000000 359.8000 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 178 1909.250000 159576.7200 83.5808
-----------------------------------------------------------------------------------------------------------------------
Total 2373.830000 191243.7300 80.5634
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 283
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 406 357.530000 54565.3500 33717.2200
D 1730 1775.050000 123598.8000 31.5700
S 0 0.000000 0.0000 0.0000
H 1 1.000000 71.9600 0.0000
T 0 0.000000 0.0000 0.0000
244 240.250000 13007.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2381 2373.830000 191243.7300 33748.7900