CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
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 2 1.750000 65.1000 37.2000
Subtotal (Total Children Is Unduplicated) 2 1.750000 65.1000 37.2000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 10 8.500000 425.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 7.500000 416.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 36.000000 2720.9300 75.5814
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 25.500000 1876.4200 73.5851
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.000000 683.9700 75.9967
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 16.000000 1241.8600 77.6163
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 18.500000 1408.4300 76.1314
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 13.500000 1036.4200 76.7719
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 97 175.000000 9847.3100 56.2703
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 41 73.000000 3988.7000 54.6397
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 121.500000 9312.7000 76.6477
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 84.500000 6531.8500 77.3000
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 219.0400 54.7600
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 48.000000 2514.5800 52.3871
Subtotal (Total Children Is Unduplicated) 218 657.000000 43238.5100 65.8120
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 506 3229.750000 161669.5000 50.0564
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 88 332.500000 16629.0000 50.0120
OCCT-97530-OT SESSION BY LICENSED OT 23 157.000000 11559.8000 73.6293
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 20.000000 1439.2000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 65 410.500000 29566.5800 72.0258
PHY-97110GT-PT SESSION BY LICENSED PT 7 19.750000 1486.7300 75.2775
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 97 641.500000 46564.8200 72.5874
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 54.500000 3949.9000 72.4752
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 4.000000 55.8400 13.9600
Subtotal (Total Children Is Unduplicated) 626 4877.500000 273279.3300 56.0286
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Total 5536.250000 316582.9400 57.1836
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Number of Children (Unduplicated) With at Least One Service 723
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Center 01
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 4643 4711.000000 262236.2300 262176.2300
D 42 42.000000 2439.8300 0.0000
S 1 1.000000 50.0000 0.0000
H 471 618.000000 40818.2500 0.0000
T 1 1.000000 71.9600 71.9600
142 163.250000 10966.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5300 5536.250000 316582.9400 262248.1900