CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:OTHER
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 130 222.750000 8267.7000 37.1165
Subtotal (Total Children Is Unduplicated) 130 222.750000 8267.7000 37.1165
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.000000 566.8600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 179.7600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 4.500000 269.6400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 36.500000 2955.7700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 22.000000 1781.5600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 38.500000 3117.7300 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 42 66.000000 5344.6800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 445.3900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 44 75.500000 4523.9600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 51 78.000000 4673.7600 59.9200
Subtotal (Total Children Is Unduplicated) 112 345.000000 24547.4400 71.1520
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.500000 325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 56 219.000000 11826.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 89 400.000000 1884.0000 4.7100
OCCT-97530-OT SESSION BY LICENSED OT 20 70.000000 5692.4000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 18 72.750000 5916.0300 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 110.000000 8945.2000 81.3200
TRAV-TRAVS-Travel by mile 111 4608.000000 2049.2900 0.4447
Subtotal (Total Children Is Unduplicated) 144 5489.250000 36762.9200 6.6973
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Total 6057.000000 69578.0600 11.4872
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Number of Children (Unduplicated) With at Least One Service 283
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Center 09
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 601 2360.500000 18019.2800 18019.2800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 300 482.500000 28615.0100 0.0000
T 792 3152.250000 20646.6700 20646.6700
66 61.750000 2297.1000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1759 6057.000000 69578.0600 38665.9500