CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 42.000000 3150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2400.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 24.000000 1761.0000 73.3750
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 23.500000 1304.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.500000 1526.2500 55.5000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 3.000000 150.0000 50.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 24 228.000000 11047.4400 48.4537
Subtotal (Total Children Is Unduplicated) 112 446.000000 26084.2800 58.4849
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2177.7400 1088.8700
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 159.000000 7950.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 2 13.000000 39.0000 3.0000
OCCT-97530-OT SESSION BY LICENSED OT 56 271.500000 19423.9900 71.5432
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 11 62.000000 3571.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 126 739.500000 53051.5500 71.7398
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 199 1325.750000 94564.4700 71.3290
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 17.000000 979.2000 57.6000
TRAV-TRAVS-Travel by mile 1 64.000000 28.4700 0.4448
Subtotal (Total Children Is Unduplicated) 365 2655.750000 181929.5400 68.5040
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Total 3101.750000 208013.8200 67.0634
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Number of Children (Unduplicated) With at Least One Service 437
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Center 09
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 2905 2961.500000 196253.0900 196325.0500
D 4 4.000000 202.0300 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 11 7.500000 572.4600 572.4600
118 119.250000 10341.9900 8164.2500
Other 5 9.500000 644.2500 0.0000
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Total 3043 3101.750000 208013.8200 205061.7600