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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.250000 9.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 6.750000 251.1000 37.2000
Subtotal (Total Children Is Unduplicated) 6 7.000000 260.4000 37.2000
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 7.500000 607.3500 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 16 31.000000 2510.3800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 25.500000 2064.9900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
SCREEN-T1023-SCREENING 1 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 41 80.500000 6500.7400 80.7545
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 8 15.000000 1079.4000 71.9600
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 54.000000 2916.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 8.000000 432.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 92.000000 7481.4400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 12 44.000000 3578.0800 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 8 10.000000 813.2000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 4.500000 365.9400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 5 32.000000 2083.8400 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 4 5.750000 374.4400 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 2 6.000000 487.9200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 17 60.000000 4879.2000 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 2 4.000000 325.2800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 89.000000 7237.4800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 14.250000 1158.8100 81.3200
Subtotal (Total Children Is Unduplicated) 100 442.500000 33410.9700 75.5050
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Total 530.000000 40172.1100 75.7964
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Number of Children (Unduplicated) With at Least One Service 136
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Center 54
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 7 5.280000 429.8600 429.8600
D 48 49.220000 3597.9800 0.0000
S 1 0.250000 9.3000 0.0000
H 105 105.250000 8147.2100 0.0000
T 8 8.000000 595.9200 0.0000
328 362.000000 27391.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 497 530.000000 40172.1100 429.8600