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: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 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 39.000000 2625.0000 67.3077
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 39.000000 2775.0000 71.1538
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 42.000000 2331.0000 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 8.000000 359.8700 44.9838
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 18.000000 668.3300 37.1294
Subtotal (Total Children Is Unduplicated) 54 166.000000 10110.6100 60.9073
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 89 439.250000 21962.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 111.000000 6989.4800 62.9683
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 21 58.000000 4159.2800 71.7117
PHY-97110HM-PT SESSION BY PT ASST 11 62.000000 3568.7200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 255.750000 16662.3600 65.1510
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 166 928.000000 53486.2600 57.6361
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Total 1094.000000 63596.8700 58.1324
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Number of Children (Unduplicated) With at Least One Service 206
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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 760 816.250000 46304.1500 46304.1500
270 277.750000 17292.7200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1030 1094.000000 63596.8700 46304.1500