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: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 5 9.000000 334.8000 37.2000
Subtotal (Total Children Is Unduplicated) 5 9.000000 334.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 14.000000 971.7600 69.4114
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 74.000000 5668.6000 76.6027
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 40.000000 3158.2200 78.9555
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 26.000000 2105.4800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 58.000000 3475.3600 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 348.6600 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 6 6.000000 323.8800 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 2.000000 51.3200 25.6600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 12 51.000000 2601.0000 51.0000
Subtotal (Total Children Is Unduplicated) 82 295.000000 19898.3400 67.4520
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 183 777.500000 41938.8500 53.9406
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 6.000000 324.0000 54.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 28.000000 2276.9600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 10 28.000000 2276.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 2 3.000000 195.3600 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 37 124.750000 9072.2400 72.7234
PHY-97110HM-PT SESSION BY PT ASST 8 13.000000 846.5600 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 192.6400 64.2133
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 230.500000 17649.7400 76.5715
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 270 1218.750000 75079.2700 61.6035
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Total 1522.750000 95312.4100 62.5923
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Number of Children (Unduplicated) With at Least One Service 317
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Center 52
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 47 46.000000 2606.6100 1741.8800
D 44 47.750000 3920.2900 0.0000
S 0 0.000000 0.0000 0.0000
H 72 79.000000 6082.5500 0.0000
T 993 1022.500000 59804.7000 52336.2100
267 325.500000 22858.2600 0.0000
Other 2 2.000000 40.0000 40.0000
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Total 1425 1522.750000 95312.4100 54118.0900