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:EIP DEI DEIP
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 8.500000 316.2000 37.2000
Subtotal (Total Children Is Unduplicated) 6 8.500000 316.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 39.500000 2962.5000 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 9 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 36.000000 2475.3000 68.7583
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 6.000000 285.2000 47.5333
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 60.500000 3357.7500 55.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 17.000000 873.9700 51.4100
Subtotal (Total Children Is Unduplicated) 51 194.000000 12468.5400 64.2708
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 103 496.500000 24837.5000 50.0252
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 36.000000 1800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 64.000000 4605.4400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 22 147.250000 9329.6000 63.3589
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 116.750000 6977.4100 59.7637
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 161 866.500000 47959.7500 55.3488
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Total 1069.000000 60744.4900 56.8237
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Number of Children (Unduplicated) With at Least One Service 196
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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 147 169.750000 11049.2200 12182.4600
D 125 135.750000 9232.1400 15.0000
S 0 0.000000 0.0000 0.0000
H 10 15.000000 1109.8000 0.0000
T 574 578.750000 30558.7800 22221.3500
141 169.750000 8794.5500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 997 1069.000000 60744.4900 34418.8100