CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 4 4.000000 200.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 299.6000 59.9200
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 6 9.500000 769.3100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.500000 149.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 7.000000 418.5600 59.7943
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 202.4500 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 3.000000 242.9400 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 29 50.500000 3356.0200 66.4558
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EI Services,Class #03
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 237 1770.500000 95593.5000 53.9924
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 20 81.750000 4414.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 23 123.750000 10063.3500 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 11.000000 894.5200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 36 279.750000 22664.1900 81.0159
PHY-97110GT-PT SESSION BY LICENSED PT 5 13.750000 1118.1500 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 57 375.750000 30323.8400 80.7022
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 13.000000 1057.1600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 10.000000 651.2000 65.1200
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 6.000000 94.5600 15.7600
Subtotal (Total Children Is Unduplicated) 299 2692.250000 167300.2500 62.1414
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Total 2742.750000 170656.2700 62.2209
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Number of Children (Unduplicated) With at Least One Service 309
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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 1298 1293.000000 79067.1500 79067.1500
D 38 38.000000 2579.3000 0.0000
S 2 2.000000 162.6400 0.0000
H 184 197.000000 13693.8400 0.0000
T 1152 1150.750000 70774.4300 68664.0500
60 62.000000 4378.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2734 2742.750000 170656.2700 147731.2000