CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2025 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
Screening, Eval, and Assessment,Class #02
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 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 607.3500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.000000 599.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.000000 898.8000 59.9200
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 23 57.500000 4006.7800 69.6831
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 315 2290.000000 123660.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 3.000000 162.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 113.250000 9209.4900 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 8 56.000000 3646.7200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 18 126.000000 10246.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 12.000000 781.4400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 407.000000 33097.2400 81.3200
Subtotal (Total Children Is Unduplicated) 344 3007.250000 180803.2100 60.1224
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Total 3064.750000 184809.9900 60.3018
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Number of Children (Unduplicated) With at Least One Service 354
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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 24 24.000000 1514.5600 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
2987 2996.750000 180456.2100 0.0000
Other 17 30.000000 2029.2600 0.0000
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Total 3041 3064.750000 184809.9900 0.0000