CMS/EIP Fiscal Report Center: 54
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 826 2697.000000 100309.8000 37.1931
Subtotal (Total Children Is Unduplicated) 826 2697.000000 100309.8000 37.1931
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 2.000000 233.6600 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 607.3500 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 659.1200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.000000 1295.6800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 14 28.000000 2267.4400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 35.000000 2834.3000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 36 66.000000 5344.6800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 17.500000 1417.1500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 49.000000 2936.0800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 44 86.500000 5183.0800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3563.1200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1133.7200 80.9800
SCREEN-T1023-SCREENING 4 4.000000 215.9200 53.9800
Subtotal (Total Children Is Unduplicated) 135 409.000000 29866.6000 73.0235
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 191.7600 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 143.9200 71.9600
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 20.000000 540.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 371 1463.250000 79069.5000 54.0369
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 107 192.750000 10408.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 8.000000 650.5600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 65.1200 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 67 341.000000 27750.4500 81.3796
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 10 24.000000 1951.6800 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 8 11.000000 716.3200 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 19 80.000000 5209.6000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 11 30.000000 2439.6000 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 35 164.500000 13377.1400 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 6 6.250000 508.2500 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 55.000000 4472.6000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 6.500000 528.5800 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 34 104.500000 8497.9400 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 588 2521.750000 157172.0800 62.3266
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Total 5627.750000 287348.4800 51.0592
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Number of Children (Unduplicated) With at Least One Service 897
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Center 54
Flag Claims Units Chgs Paid
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R 86 85.250000 4045.9500 0.0000
U 0 0.000000 0.0000 0.0000
B 1764 1631.500000 79058.8600 0.0000
P 2382 2141.750000 108083.2800 107562.0800
D 15 11.000000 707.0100 0.0000
S 106 97.250000 3750.0600 0.0000
H 2 2.000000 162.6400 0.0000
T 2 2.000000 74.4000 0.0000
1473 1529.250000 85332.9800 0.0000
Other 173 127.750000 6133.3000 719.1700
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Total 6003 5627.750000 287348.4800 108281.2500