CMS/EIP Fiscal Report Center: 55
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 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 48 95.000000 7681.1400 80.8541
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.999999 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1457.6400 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 9 8.197212 476.3400 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 1.938393 112.6400 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 5.345724 310.6400 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 3.075374 178.7100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 5.490105 319.0300 58.1100
Subtotal (Total Children Is Unduplicated) 77 150.046807 11566.0100 77.0827
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 16.000000 864.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 136.521888 11101.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 27 153.490942 9951.8700 64.8369
PHY-97110-PT SESSION BY LICENSED PT 17 66.509836 5408.5800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 19 105.498148 6870.0400 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 3.000000 195.3600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 66 391.048933 31800.1000 81.3200
Subtotal (Total Children Is Unduplicated) 136 873.069747 66241.9100 75.8724
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Total 1023.116554 77807.9200 76.0499
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Number of Children (Unduplicated) With at Least One Service 176
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Center 55
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 541 524.938050 40098.6300 40098.6300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 45 82.000000 6630.7800 0.0000
T 8 8.000000 650.5600 650.5600
512 408.178504 30427.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1106 1023.116554 77807.9200 40749.1900