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:Program Patients
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 7 16.000000 1133.7200 70.8575
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 4 8.000000 479.3600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 110.000000 8386.9200 76.2447
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 24 48.000000 3806.0600 79.2929
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 44.000000 3386.1600 76.9582
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 44 88.000000 5272.9600 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) 107 397.000000 27110.4600 68.2883
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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 1624.750000 102524.5300 63.1017
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Number of Children (Unduplicated) With at Least One Service 342
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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 49 50.000000 2716.6100 1851.8800
D 47 53.750000 4406.1700 0.0000
S 0 0.000000 0.0000 0.0000
H 78 91.000000 7054.3100 0.0000
T 1010 1056.500000 62187.4200 54673.9300
290 371.500000 26120.0200 0.0000
Other 2 2.000000 40.0000 40.0000
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Total 1476 1624.750000 102524.5300 56565.8100