CMS/EIP Fiscal Report Center: 52
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:MED
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 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 36.000000 2700.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 280.5000 70.1250
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 4 5.000000 250.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 21.000000 1079.6100 51.4100
Subtotal (Total Children Is Unduplicated) 39 92.000000 6118.5700 66.5062
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 113 480.750000 24049.5000 50.0250
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
OCCT-97530TL-OT SESSION BY LICENSED OT 14 59.000000 4245.6400 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 14 41.000000 2950.3600 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 9 44.000000 2532.6400 57.5600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 188.000000 13528.4800 71.9600
Subtotal (Total Children Is Unduplicated) 165 813.750000 47356.6200 58.1955
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Total 905.750000 53475.1900 59.0397
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Number of Children (Unduplicated) With at Least One Service 195
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Center 52
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
883 905.750000 53475.1900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 883 905.750000 53475.1900 0.0000