CMS/EIP Fiscal Report Center: 51
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 3 3.000000 181.9100 60.6367
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 6.000000 431.7600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 5 19.500000 1403.2200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 8.000000 575.6800 71.9600
Subtotal (Total Children Is Unduplicated) 8 35.500000 2510.6600 70.7228
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Total 38.500000 2692.5700 69.9369
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Number of Children (Unduplicated) With at Least One Service 10
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Center 51
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 13 12.500000 838.0700 838.0700
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
26 26.000000 1854.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 39 38.500000 2692.5700 838.0700