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:EIP DEI DEIP
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 1013 7701.750000 286505.1000 37.2000
Subtotal (Total Children Is Unduplicated) 1013 7701.750000 286505.1000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.000000 485.8800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.000000 566.8600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
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 10 19.500000 1124.2400 57.6533
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 17.000000 992.1200 58.3600
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 67.500000 5176.1200 76.6833
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 48.000000 3692.6900 76.9310
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 23.500000 1810.3400 77.0357
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 13.500000 1045.3900 77.4363
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.500000 967.4000 77.3920
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 635.8800 79.4850
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 144.500000 8046.2700 55.6835
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 43 81.500000 4693.4200 57.5880
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 167.6300 55.8767
SPCH-92522TLGT-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 209 463.500000 30272.5600 65.3130
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 176.000000 9265.0000 52.6420
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 30.000000 1588.0000 52.9333
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 4 5.000000 359.8000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.000000 431.7600 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 4 49.000000 3975.3200 81.1290
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 10.000000 813.2000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 325.2800 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 19.000000 1545.0800 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 569.2400 81.3200
Subtotal (Total Children Is Unduplicated) 34 311.000000 19260.5600 61.9311
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Total 8476.250000 336038.2200 39.6447
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Number of Children (Unduplicated) With at Least One Service 1026
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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 0 0.000000 0.0000 0.0000
D 1 2.500000 93.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8010 8230.750000 326755.1400 326142.8800
T 0 0.000000 0.0000 0.0000
210 241.000000 9070.2400 0.0000
Other 1 2.000000 119.8400 0.0000
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Total 8222 8476.250000 336038.2200 326142.8800