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
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
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 209.7200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 24.000000 1943.5200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 23 45.000000 3644.1000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 29.000000 2348.4200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 31 60.500000 4899.2900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 15.500000 1255.1900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 566.8600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 34.500000 2067.2400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 32 61.000000 3655.1200 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 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-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 20 206.000000 11970.6600 58.1100
Subtotal (Total Children Is Unduplicated) 137 508.000000 33944.5000 66.8199
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 108.000000 5832.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 108.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 62 285.500000 23216.8600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 9 54.000000 3465.1500 64.1694
PHY-97110-PT SESSION BY LICENSED PT 130 748.250000 60115.8100 80.3419
PHY-97110HM-PT SESSION BY PT ASST 2 6.000000 390.7200 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 459.2200 229.6100
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 156 849.500000 67536.2600 79.5012
TRAV-TRAVS-Travel by mile 1 6.000000 2.6700 0.4450
Subtotal (Total Children Is Unduplicated) 286 2063.250000 161162.9500 78.1112
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Total 2571.250000 195107.4500 75.8804
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Number of Children (Unduplicated) With at Least One Service 393
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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 1232 1230.500000 95695.5500 95695.5500
D 50 50.000000 1533.7300 81.3200
S 86 85.750000 6863.9100 0.0000
H 0 0.000000 0.0000 0.0000
T 682 671.000000 51810.3500 51810.3500
399 403.000000 29616.9400 1665.3500
Other 67 131.000000 9586.9700 0.0000
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Total 2516 2571.250000 195107.4500 149252.5700