CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
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 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 43.4500 28.9667
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 33 61.500000 4567.1900 74.2633
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 82.000000 6418.6400 78.2761
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 268.2000 44.7000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 126.3700 42.1233
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 82 186.000000 13363.5000 71.8468
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 432.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 50.500000 3190.6300 63.1808
PHY-97110-PT SESSION BY LICENSED PT 24 117.250000 8543.3400 72.8643
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 160.750000 11579.9800 72.0372
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 82 338.500000 23881.2700 70.5503
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Total 524.500000 37244.7700 71.0100
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Number of Children (Unduplicated) With at Least One Service 147
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Center 03
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 329 397.500000 27943.8300 27943.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 29 29.000000 2219.9000 2219.9000
T 0 0.000000 0.0000 0.0000
88 98.000000 7081.0400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 446 524.500000 37244.7700 30163.7300