CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 849 2927.500000 108837.9000 37.1778
Subtotal (Total Children Is Unduplicated) 849 2927.500000 108837.9000 37.1778
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Screening, Eval, and Assessment,Class #02
AACIS-92597TLGT-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 809.8000 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 14.000000 838.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 25.500000 2064.9900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1619.6000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 47.000000 3672.6300 78.1411
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 83.000000 6721.3400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 18 30.500000 2469.8900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.500000 749.0000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 40 78.000000 4664.9200 59.8067
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2915.2800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 26.000000 2105.4800 80.9800
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 180 406.000000 30543.6900 75.2308
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 2 2.000000 95.8800 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 143.8200 47.9400
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 305.500000 16524.0000 54.0884
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 70.000000 3780.0000 54.0000
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 260.4800 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 2 5.750000 487.9200 84.8557
OCCT-97530TLGO-OT SESSION BY LICENSED OT 75 320.250000 26014.5700 81.2321
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 9 9.750000 792.8700 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 5 7.000000 455.8400 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 15 60.000000 3907.2000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 38 176.750000 14373.3100 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 8 10.000000 813.2000 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 33 104.500000 8497.9400 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 12.750000 1036.8300 81.3200
Subtotal (Total Children Is Unduplicated) 265 1094.250000 77427.8200 70.7588
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Total 4427.750000 216809.4100 48.9660
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Number of Children (Unduplicated) With at Least One Service 869
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Center 54
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 170 169.750000 8056.6200 74.4200
P 4556 4258.000000 208752.7900 207319.6800
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4726 4427.750000 216809.4100 207394.1000