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: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 1827 9928.000000 369219.3000 37.1897
Subtotal (Total Children Is Unduplicated) 1827 9928.000000 369219.3000 37.1897
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 23.500000 1891.0700 80.4711
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 236.9600 78.9867
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 28 46.000000 2696.6500 58.6228
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 13 23.500000 1903.0300 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 73.000000 5648.4200 77.3756
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 32.000000 2492.6900 77.8966
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 20.000000 1547.8400 77.3920
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 15 25.000000 1904.9000 76.1960
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 25.500000 1984.2600 77.8141
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 22.000000 1721.7600 78.2618
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 188.500000 10819.7700 57.3993
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 33 56.000000 3154.4100 56.3288
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 120 206.500000 15924.0400 77.1140
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 168.500000 12963.4100 76.9342
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 24.000000 1394.6400 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 45.000000 2561.3500 56.9189
Subtotal (Total Children Is Unduplicated) 421 995.500000 69804.8300 70.1204
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 164 1004.500000 52860.0000 52.6232
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 36 64.500000 3363.0000 52.1395
OCCT-97530-OT SESSION BY LICENSED OT 16 101.000000 8063.5600 79.8372
OCCT-97530GT-OT SESSION BY LICENSED OT 6 31.000000 2520.9200 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 13 91.000000 7035.0800 77.3086
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 24.000000 1876.8000 78.2000
PHY-97110-PT SESSION BY LICENSED PT 12 77.750000 6303.9100 81.0792
PHY-97110GT-PT SESSION BY LICENSED PT 5 25.750000 2093.9900 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 14 120.500000 9572.0800 79.4363
PHY-97110TLGT-PT SESSION BY LICENSED PT 6 14.000000 1072.9600 76.6400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 83.250000 6472.7100 77.7503
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 10 43.750000 3382.2500 77.3086
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 248 1684.000000 104851.8600 62.2636
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Total 12607.500000 543875.9900 43.1391
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Number of Children (Unduplicated) With at Least One Service 1848
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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 2 0.750000 27.9000 0.0000
P 6 6.000000 304.0000 304.0000
D 454 458.250000 25388.1600 0.0000
S 871 752.250000 39395.6800 0.0000
H 15156 11298.000000 475240.3100 475231.0100
T 2 2.000000 162.6400 162.6400
45 32.750000 1218.3000 0.0000
Other 125 57.500000 2139.0000 0.0000
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Total 16661 12607.500000 543875.9900 475697.6500