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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.750000 27.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 8.250000 306.9000 37.2000
Subtotal (Total Children Is Unduplicated) 4 9.000000 334.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 595.3900 79.3853
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 769.3100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.500000 1243.2300 80.2084
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 16 31.000000 2953.0300 95.2590
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 419.4400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 947.8400 78.9867
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 43 94.500000 7773.6400 82.2607
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 8.000000 575.6800 71.9600
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 47.000000 2606.0000 55.4468
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 5.000000 270.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 27 268.380000 7778.0800 28.9816
OCCT-97530GO-OT SESSION BY LICENSED OT 13 40.000000 3215.3600 80.3840
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 17.000000 1382.4400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 5 8.500000 691.2200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 2 10.000000 651.2000 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 5.000000 406.6000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 13 44.870000 3751.4500 83.6071
PHY-97110GT-PT SESSION BY LICENSED PT 3 2.870000 233.4900 81.3554
PHY-97110TL-PT SESSION BY LICENSED PT 1 5.000000 406.6000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 85.840000 7885.7200 91.8653
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 14.000000 1317.4900 94.1064
Subtotal (Total Children Is Unduplicated) 89 566.460000 31451.5700 55.5230
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Total 669.960000 39560.0100 59.0483
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Number of Children (Unduplicated) With at Least One Service 120
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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 0 0.000000 0.0000 0.0000
P 58 67.510000 6499.1500 4796.0300
D 209 381.450000 16926.9600 0.0000
S 1 2.000000 161.9600 0.0000
H 14 15.000000 1202.9200 0.0000
T 0 0.000000 0.0000 0.0000
194 202.000000 14607.0600 0.0000
Other 1 2.000000 161.9600 0.0000
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Total 477 669.960000 39560.0100 4796.0300