CMS/EIP Fiscal Report Center: 05
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 6.500000 520.3900 80.0600
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 131.4300 43.8100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 3.000000 154.2300 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 2.000000 66.3800 33.1900
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 138.8900 34.7225
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 5 5.000000 231.8200 46.3640
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 283.8500 56.7700
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 17.000000 832.1500 48.9500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 109.5200 54.7600
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 4.000000 103.0400 25.7600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 9 62.000000 2310.6400 37.2684
Subtotal (Total Children Is Unduplicated) 48 124.000000 5492.8600 44.2973
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 521.500000 27597.0000 52.9185
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.500000 81.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 248.750000 18013.9600 72.4179
PHY-97110-PT SESSION BY LICENSED PT 47 446.500000 27077.1000 60.6430
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 579.000000 37624.2900 64.9815
Subtotal (Total Children Is Unduplicated) 126 1800.250000 110609.2300 61.4410
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Total 1924.250000 116102.0900 60.3363
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Number of Children (Unduplicated) With at Least One Service 129
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Center 05
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 2176 1915.250000 115554.9800 115554.9800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9 9.000000 547.1100 547.1100
Other 0 0.000000 0.0000 0.0000
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Total 2185 1924.250000 116102.0900 116102.0900