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: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
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 0.500000 40.4900 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 449.4000 59.9200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 10 22.000000 1454.8000 66.1273
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 0.750000 0.0000 0.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 5.000000 406.6000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 5 21.750000 1768.7100 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 69.750000 5648.8600 80.9872
Subtotal (Total Children Is Unduplicated) 17 97.250000 7824.1700 80.4542
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Total 119.250000 9278.9700 77.8111
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Number of Children (Unduplicated) With at Least One Service 24
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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 64 68.000000 5327.5400 5327.5400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 20 20.750000 1644.5900 1644.5900
T 6 7.000000 503.2300 503.2300
25 23.500000 1803.6100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 115 119.250000 9278.9700 7475.3600