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
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 383 1141.750000 42119.7000 36.8905
Subtotal (Total Children Is Unduplicated) 383 1141.750000 42119.7000 36.8905
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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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 599.2000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 47.000000 3806.0600 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-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 33.000000 2672.3400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 105.000000 6291.6000 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
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 4 4.000000 215.9200 53.9800
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 290.5500 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 87 256.000000 17903.6700 69.9362
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 250 1053.000000 56862.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 16 67.000000 3618.0000 54.0000
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 23 90.500000 7359.4600 81.3200
OCCT-97530TLHM-OT SESSION BY OT ASST 3 5.000000 325.6000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 21.3200 21.3200
PHY-97110TL-PT SESSION BY LICENSED PT 28 79.750000 6485.2700 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 7 36.000000 2344.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 1.500000 121.9800 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 34 130.000000 10612.2600 81.6328
Subtotal (Total Children Is Unduplicated) 323 1465.750000 87912.8500 59.9781
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Total 2863.500000 147936.2200 51.6627
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Number of Children (Unduplicated) With at Least One Service 487
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Center 52
Flag Claims Units Chgs Paid
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R 52 54.250000 3605.2900 0.0000
U 0 0.000000 0.0000 0.0000
B 537 565.250000 23844.6600 0.0000
P 1374 1437.750000 74286.5800 74209.7900
D 1 1.000000 81.3200 0.0000
S 29 32.250000 1304.0600 32.3900
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
745 765.750000 44544.6100 0.0000
Other 6 7.250000 269.7000 241.8000
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Total 2744 2863.500000 147936.2200 74483.9800