CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 991 3292.750000 122527.5000 37.2113
Subtotal (Total Children Is Unduplicated) 991 3292.750000 122527.5000 37.2113
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 87.000000 6375.0000 73.2759
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 55 97.500000 7312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 79.500000 5858.2500 73.6887
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 47 82.500000 6187.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 29.500000 2212.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 26 49.500000 3712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 77.500000 4245.7500 54.7839
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 61 112.000000 6216.0000 55.5000
Subtotal (Total Children Is Unduplicated) 179 626.000000 42886.5000 68.5088
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 537 4070.250000 203980.1000 50.1149
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 131 620.000000 30995.5000 49.9927
OCCT-97530-OT SESSION BY LICENSED OT 2 7.000000 503.7200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 4.000000 287.8400 71.9600
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.500000 201.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 6 65.000000 4545.6400 69.9329
PHY-97110HM-PT SESSION BY PT ASST 8 48.250000 2770.4400 57.4184
PHY-97110HMGT-PT SESSION BY PT ASST 4 25.000000 1439.0000 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 28.000000 1970.9600 70.3914
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 24.750000 1781.0100 71.9600
Subtotal (Total Children Is Unduplicated) 633 4896.750000 248547.7700 50.7577
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Total 8815.500000 413961.7700 46.9584
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Number of Children (Unduplicated) With at Least One Service 1057
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Center 06
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9808 8815.500000 413961.7700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9808 8815.500000 413961.7700 0.0000