CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 391 1136.250000 41868.6000 36.8481
Subtotal (Total Children Is Unduplicated) 391 1136.250000 41868.6000 36.8481
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 18.000000 1078.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 31.000000 2510.3800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 26.000000 2105.4800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 37.000000 2996.2600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 63 125.000000 7490.0000 59.9200
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167TL-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-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 88 267.000000 18472.8600 69.1867
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 132 541.500000 29241.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 16 67.000000 3618.0000 54.0000
OCCT-97530TLGO-OT SESSION BY LICENSED OT 22 86.500000 7034.1800 81.3200
OCCT-97530TLHM-OT SESSION BY OT ASST 3 5.000000 325.6000 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 16 47.750000 3883.0300 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 15 53.500000 4350.6200 81.3200
Subtotal (Total Children Is Unduplicated) 187 801.250000 48452.4300 60.4711
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Total 2204.500000 108793.8900 49.3508
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Number of Children (Unduplicated) With at Least One Service 466
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Center 52
Flag Claims Units Chgs Paid
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R 55 59.000000 3869.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 575 624.500000 26538.6400 0.0000
P 1425 1521.000000 78385.7000 78296.9500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2055 2204.500000 108793.8900 78296.9500