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
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 70 127.500000 9523.5000 74.6941
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 27.500000 2062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 72.000000 5400.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 47 90.500000 6787.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 46.000000 3411.0000 74.1522
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 15.500000 1162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 102 188.500000 10569.0000 56.0690
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 72 137.500000 7670.2500 55.7836
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 3.000000 150.0000 50.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
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 4 4.000000 212.3400 53.0850
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 24 228.000000 11047.4400 48.4537
Subtotal (Total Children Is Unduplicated) 253 993.500000 61485.1700 61.8874
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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 51 162.000000 8100.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 2 13.000000 39.0000 3.0000
OCCT-97530-OT SESSION BY LICENSED OT 58 274.500000 19639.8700 71.5478
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 6.000000 431.7600 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 209 1396.000000 99619.6600 71.3608
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 143.9200 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) 381 2742.000000 188070.2100 68.5887
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Total 3735.500000 249555.3800 66.8064
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Number of Children (Unduplicated) With at Least One Service 585
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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 3141 3334.250000 221038.3900 211564.3500
D 4 4.000000 202.0300 0.0000
S 0 0.000000 0.0000 0.0000
H 142 248.000000 15995.7600 15884.7600
T 11 7.500000 572.4600 572.4600
119 120.750000 10425.2400 8247.5000
Other 11 21.000000 1321.5000 0.0000
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Total 3428 3735.500000 249555.3800 236269.0700