CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 236.9600 78.9867
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 382.8500 58.9000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.500000 418.4800 76.0873
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 7.500000 498.3400 66.4453
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 383.9700 76.7940
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 41.000000 2319.7000 56.5780
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 20.000000 1151.9900 57.5995
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 20.000000 1532.8900 76.6445
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1526.9100 76.3455
Subtotal (Total Children Is Unduplicated) 53 142.500000 9446.9300 66.2942
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 8.000000 420.0000 52.5000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 17.000000 902.0000 53.0588
OCCT-97530-OT SESSION BY LICENSED OT 1 28.000000 2192.7200 78.3114
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 63.000000 5029.5600 79.8343
Subtotal (Total Children Is Unduplicated) 3 116.000000 8544.2800 73.6576
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Total 258.500000 17991.2100 69.5985
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Number of Children (Unduplicated) With at Least One Service 55
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Center 01
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 124 146.000000 10000.1800 10000.1800
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 75 100.500000 7125.2600 0.0000
T 1 2.000000 119.8400 119.8400
5 8.000000 595.9300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 206 258.500000 17991.2100 10120.0200