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: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 8 9.250000 344.1000 37.2000
Subtotal (Total Children Is Unduplicated) 8 9.250000 344.1000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 554.9000 79.2714
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 445.3900 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 461.9600 76.9933
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 242.9400 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 271.4700 77.5629
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 311.8800 56.7055
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 15.500000 911.0800 58.7794
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 50.000000 3773.7900 75.4758
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.000000 1253.8200 78.3638
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 20.500000 1573.3800 76.7502
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 18 33.500000 2539.4100 75.8033
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 721.4700 75.9442
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 461.9600 76.9933
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 84.000000 4700.0900 55.9535
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 35 68.000000 3914.6600 57.5685
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 7.000000 453.1900 64.7414
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 642.3200 58.3927
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 147 356.500000 23517.5600 65.9679
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 4.000000 204.0000 51.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 51.000000 4119.2400 80.7694
OCCT-97530GO-OT SESSION BY LICENSED OT 6 31.750000 2563.1900 80.7304
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 2.000000 143.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 317.000000 25097.6900 79.1725
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 153.2800 76.6400
Subtotal (Total Children Is Unduplicated) 34 414.000000 32641.1200 78.8433
-----------------------------------------------------------------------------------------------------------------------
Total 779.750000 56502.7800 72.4627
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 168
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 460 548.500000 40220.0000 33153.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 133 200.750000 13975.9400 13864.9400
T 6 7.000000 503.2300 503.2300
25 23.500000 1803.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 624 779.750000 56502.7800 47521.6700