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
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 10.000000 647.8400 64.7840
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 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 52.000000 3887.0400 74.7508
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2591.3600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 4 4.000000 215.9200 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 40 132.000000 9449.2000 71.5848
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 94 423.000000 22803.8500 53.9098
OCCT-97530GO-OT SESSION BY LICENSED OT 6 15.000000 1219.8000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 12 22.000000 1789.0400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 8 13.000000 846.5600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 102.750000 7867.7100 76.5714
Subtotal (Total Children Is Unduplicated) 136 575.750000 34526.9600 59.9687
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Total 707.750000 43976.1600 62.1352
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Number of Children (Unduplicated) With at Least One Service 167
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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 0 0.000000 0.0000 0.0000
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 508 534.000000 30737.7000 30737.7000
145 173.750000 13238.4600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 653 707.750000 43976.1600 30737.7000