CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
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-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 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 890.7800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 33.1900 33.1900
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 290.5500 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 13.000000 464.3900 35.7223
Subtotal (Total Children Is Unduplicated) 23 44.000000 2591.1700 58.8902
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 137.500000 7425.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 0.500000 27.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 67.250000 5294.3700 78.7267
PHY-97110-PT SESSION BY LICENSED PT 19 46.500000 3639.2700 78.2639
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 119.250000 8963.2600 75.1636
Subtotal (Total Children Is Unduplicated) 91 371.000000 25348.9000 68.3259
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Total 415.000000 27940.0700 67.3255
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Number of Children (Unduplicated) With at Least One Service 102
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Center 05
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 367 352.500000 23677.6400 23677.6400
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
78 62.500000 4262.4300 4262.4300
Other 0 0.000000 0.0000 0.0000
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Total 445 415.000000 27940.0700 27940.0700