CMS/EIP Fiscal Report Center: 09
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:MED
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 1 0.750000 27.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1 0.750000 27.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 611.9600 76.4950
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 611.9600 76.4950
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 18.000000 1322.8400 73.4911
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 434.9200 72.4867
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.500000 380.6400 58.5600
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 590.3600 59.0360
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 77.500000 5812.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 17 33.500000 2664.9900 79.5519
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 36.000000 2700.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 85.500000 6636.7500 77.6228
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 769.3100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 56.500000 3280.8300 58.0678
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 41 78.500000 4493.7700 57.2455
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 108.000000 6155.2800 56.9933
Subtotal (Total Children Is Unduplicated) 198 569.500000 38495.6700 67.5956
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 838 15851.50000 835036.9600 52.6787
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 52 121.500000 6301.0000 51.8601
OCCT-97530-OT SESSION BY LICENSED OT 46 568.750000 44637.4700 78.4835
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 14 249.000000 15899.0400 63.8516
PHY-97110-PT SESSION BY LICENSED PT 37 712.000000 56002.6800 78.6554
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.000000 153.2800 76.6400
PHY-97110HM-PT SESSION BY PT ASST 2 29.000000 1888.4800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 1416.000000 112197.2800 79.2354
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 885 18951.75000 1072269.4700 56.5789
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Total 19522.000000 1110793.0400 56.8996
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Number of Children (Unduplicated) With at Least One Service 932
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Center 09
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 15 15.000000 810.0000 810.0000
D 76 76.000000 4209.9700 0.0000
S 13 14.000000 809.9600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
19140 19306.500000 1097229.0200 672850.2600
Other 59 110.500000 7734.0900 0.0000
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Total 19303 19522.000000 1110793.0400 673660.2600