CMS/EIP Fiscal Report Center: 07
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 2.750000 102.3000 37.2000
Subtotal (Total Children Is Unduplicated) 4 2.750000 102.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 6.000000 348.6600 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 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 6 6.000000 348.6600 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 30.000000 1743.3000 58.1100
Subtotal (Total Children Is Unduplicated) 34 68.000000 4225.9200 62.1459
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 140.500000 7587.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 3.750000 202.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 33 174.500000 14190.3400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 17.000000 1382.4400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 5 28.000000 1823.3600 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 65.1200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 22 128.000000 10408.9600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 399.500000 32487.3400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 36.000000 2344.3200 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 4 11.000000 716.3200 65.1200
Subtotal (Total Children Is Unduplicated) 121 941.250000 71370.3400 75.8251
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Total 1012.000000 75698.5600 74.8009
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Number of Children (Unduplicated) With at Least One Service 130
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Center 07
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 1011 1000.250000 74866.4200 74866.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 323.9200 0.0000
T 0 0.000000 0.0000 0.0000
9 7.750000 508.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1022 1012.000000 75698.5600 74866.4200