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:EIP DEI DEIP
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 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 22.000000 1781.5600 80.9800
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 4 8.000000 566.8600 70.8575
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 20 40.000000 2396.8000 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 5.000000 290.5500 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 2.000000 51.3200 25.6600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 9 46.000000 2310.4500 50.2272
Subtotal (Total Children Is Unduplicated) 48 163.000000 10449.1400 64.1052
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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 92 354.500000 19135.0000 53.9774
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 4 13.000000 1057.1600 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 25 102.750000 7283.2000 70.8827
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 192.6400 64.2133
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 127.750000 9782.0300 76.5717
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 147 643.000000 40552.3100 63.0674
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Total 815.000000 51336.2500 62.9893
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Number of Children (Unduplicated) With at Least One Service 180
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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 485 488.500000 29067.0000 21598.5100
122 151.750000 9619.8000 0.0000
Other 2 2.000000 40.0000 40.0000
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Total 772 815.000000 51336.2500 23380.3900