CMS/EIP Fiscal Report Center: 03
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 55.500000 3894.8600 70.1777
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 21.000000 1607.8900 76.5662
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 377.5000 68.6364
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.500000 478.3800 56.2800
Subtotal (Total Children Is Unduplicated) 37 98.500000 6964.3500 70.7041
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EI Services,Class #03
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 225.2400 75.0800
Subtotal (Total Children Is Unduplicated) 1 3.000000 225.2400 75.0800
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Total 101.500000 7189.5900 70.8334
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Number of Children (Unduplicated) With at Least One Service 38
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Center 03
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 52 88.500000 6186.8500 6186.8500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 161.9600 161.9600
T 0 0.000000 0.0000 0.0000
6 11.000000 840.7800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 59 101.500000 7189.5900 6348.8100