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
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 1679 4751.750000 176644.2000 37.1746
Subtotal (Total Children Is Unduplicated) 1679 4751.750000 176644.2000 37.1746
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.500000 813.5900 56.1097
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 59.000000 4520.6800 76.6217
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 23.500000 1825.2900 77.6719
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 15.500000 1180.4400 76.1574
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 24.000000 1823.9200 75.9967
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 17.000000 1295.9300 76.2312
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 17.000000 1316.8600 77.4624
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 152.500000 8673.7000 56.8767
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 31 54.000000 3036.7800 56.2367
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 196.500000 15087.3300 76.7803
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 146.000000 11129.4000 76.2288
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 17.000000 934.2700 54.9571
Subtotal (Total Children Is Unduplicated) 329 740.500000 51950.1500 70.1555
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 47 240.750000 12337.5000 51.2461
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 19.500000 985.0000 50.5128
OCCT-97530-OT SESSION BY LICENSED OT 3 11.000000 810.2800 73.6618
OCCT-97530TL-OT SESSION BY LICENSED OT 11 55.000000 4107.5600 74.6829
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 11.000000 819.6400 74.5127
PHY-97110-PT SESSION BY LICENSED PT 1 6.000000 469.2000 78.2000
PHY-97110TL-PT SESSION BY LICENSED PT 11 52.000000 4001.6600 76.9550
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 11.000000 829.0000 75.3636
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 7.750000 576.4100 74.3755
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 19.750000 1430.5700 72.4339
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 84 434.750000 26438.7800 60.8138
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Total 5927.000000 255033.1300 43.0290
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Number of Children (Unduplicated) With at Least One Service 1696
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 0.500000 18.6000 0.0000
H 7540 5896.250000 253889.2300 253879.9300
T 0 0.000000 0.0000 0.0000
10 6.750000 251.1000 0.0000
Other 54 23.500000 874.2000 0.0000
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Total 7606 5927.000000 255033.1300 253879.9300