CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 2.000000 100.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 64.000000 3625.1600 56.6431
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 39.000000 2336.8800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 27.500000 2307.9300 83.9247
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.000000 2105.4800 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 13.000000 801.8500 61.6808
Subtotal (Total Children Is Unduplicated) 96 184.500000 12085.7100 65.5052
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 393 2095.500000 113114.0000 53.9795
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 58 180.500000 9747.0000 54.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 77.000000 6261.6400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 38 186.750000 15136.7100 81.0533
PHY-97110GT-PT SESSION BY LICENSED PT 6 12.750000 972.8300 76.3004
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 286.250000 23277.8500 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 25.000000 2033.0000 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 6.000000 390.7200 65.1200
Subtotal (Total Children Is Unduplicated) 466 2871.750000 171065.0700 59.5682
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Total 3056.250000 183150.7800 59.9266
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Number of Children (Unduplicated) With at Least One Service 521
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Center 01
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 2367 2413.500000 144574.5100 144574.5100
D 59 59.000000 3903.3100 0.0000
S 0 0.000000 0.0000 0.0000
H 5 5.500000 387.8400 0.0000
T 567 577.250000 34203.8000 34161.6800
1 1.000000 81.3200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2999 3056.250000 183150.7800 178736.1900