CMS/EIP Fiscal Report Center: 05
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: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 2 3.500000 283.4300 80.9800
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 20.7200 10.3600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 8.000000 200.7400 25.0925
Subtotal (Total Children Is Unduplicated) 8 16.500000 679.2200 41.1648
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 118.000000 6372.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 0.500000 27.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 45.500000 3096.9900 68.0657
PHY-97110-PT SESSION BY LICENSED PT 17 41.500000 2850.5400 68.6877
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 80.500000 5978.4400 74.2663
Subtotal (Total Children Is Unduplicated) 60 286.000000 18324.9700 64.0733
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Total 302.500000 19004.1900 62.8238
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Number of Children (Unduplicated) With at Least One Service 63
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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 318 293.500000 18457.0800 18457.0800
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 327 302.500000 19004.1900 19004.1900