CMS/EIP Fiscal Report Center: 07
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:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 9 5.750000 213.9000 37.2000
Subtotal (Total Children Is Unduplicated) 9 5.750000 213.9000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 61.7100 61.7100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 38.000000 3077.2400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 30.000000 2429.4000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 39.013500 3159.3132 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 22.000000 1781.5600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1619.6000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1295.6800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.785900 711.4822 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 755.4300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 39.000000 2266.2900 58.1100
Subtotal (Total Children Is Unduplicated) 111 257.799400 19168.9754 74.3562
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 3994.7300 1997.3650
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 1.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 28 148.250000 8005.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 38 203.750000 16492.1200 80.9429
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 73.5200 73.5200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 8.000000 650.5600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 6 20.000000 1302.4000 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 31 158.000000 12848.5600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 63 325.250000 26449.3300 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 7.000000 455.8400 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 3 15.000000 976.8000 65.1200
Subtotal (Total Children Is Unduplicated) 148 900.250000 71957.7800 79.9309
-----------------------------------------------------------------------------------------------------------------------
Total 1163.799400 91340.6554 78.4849
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 242
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1000 1017.049400 79811.4054 79811.4000
D 4 8.000000 647.8400 0.0000
S 0 0.000000 0.0000 0.0000
H 12 21.000000 1701.6000 0.0000
T 0 0.000000 0.0000 0.0000
65 111.750000 8693.9300 58.1100
Other 3 6.000000 485.8800 0.0000
---------------------------------------------------------
Total 1084 1163.799400 91340.6554 79869.5100