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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 2.500000 93.0000 37.2000
Subtotal (Total Children Is Unduplicated) 3 2.500000 93.0000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 9 8.750000 437.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 12.500000 994.3100 79.5448
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 18 28.000000 1653.4500 59.0518
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 13 23.000000 1862.5400 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 39.500000 3016.3200 76.3625
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.000000 611.9600 76.4950
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 10.500000 805.4400 76.7086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 13.500000 1039.4100 76.9933
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 17.000000 1286.9600 75.7035
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 13.500000 1048.3800 77.6578
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 97.000000 5535.9900 57.0721
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1051.0600 56.8141
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 83.500000 6453.8600 77.2917
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 48.500000 3736.1700 77.0344
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
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 33.000000 1810.4300 54.8615
Subtotal (Total Children Is Unduplicated) 197 470.250000 32344.2400 68.7809
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 3.500000 175.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 37 422.750000 22349.0000 52.8658
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 21 62.000000 3268.0000 52.7097
OCCT-97530-OT SESSION BY LICENSED OT 16 163.500000 13089.9000 80.0606
OCCT-97530GO-OT SESSION BY LICENSED OT 1 7.000000 569.2400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 3.000000 234.6000 78.2000
OCCT-97530GT-OT SESSION BY LICENSED OT 5 21.000000 1670.2800 79.5371
PHY-97110-PT SESSION BY LICENSED PT 15 126.750000 10101.3900 79.6954
PHY-97110GT-PT SESSION BY LICENSED PT 4 38.500000 3102.7400 80.5906
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 263.500000 21015.9800 79.7570
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 32.000000 2564.8000 80.1500
Subtotal (Total Children Is Unduplicated) 99 1151.000000 78428.4300 68.1394
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Total 1623.750000 110865.6700 68.2775
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Number of Children (Unduplicated) With at Least One Service 271
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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 0 0.000000 0.0000 0.0000
D 4 4.000000 297.9600 0.0000
S 4 4.000000 293.9600 0.0000
H 1064 1216.750000 81703.4100 0.0000
T 0 0.000000 0.0000 0.0000
369 399.000000 28570.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1441 1623.750000 110865.6700 0.0000