CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 496 2199.500000 81263.4000 36.9463
Subtotal (Total Children Is Unduplicated) 496 2199.500000 81263.4000 36.9463
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 18.000000 1445.6800 80.3156
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 785.8800 78.5880
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 17 34.000000 2010.7600 59.1400
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 49.000000 3782.6400 77.1967
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 274.4600 78.4171
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 46.000000 3557.6400 77.3400
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1595.6800 79.7840
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 140.000000 7991.0000 57.0786
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 590.3600 59.0360
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 3 3.000000 167.6300 55.8767
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 109.5200 54.7600
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
SCREEN-T1023-SCREENING 15 15.000000 777.8600 51.8573
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 167.6300 55.8767
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 174.3300 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 188.1800 62.7267
Subtotal (Total Children Is Unduplicated) 136 393.000000 26046.6500 66.2765
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 235 2640.000000 138772.0000 52.5652
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 27 371.000000 19650.0000 52.9650
OCCT-97530-OT SESSION BY LICENSED OT 13 43.000000 3103.6400 72.1777
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 25 205.000000 16463.2200 80.3084
OCCT-97530TLHM-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 3 4.000000 297.2000 74.3000
PHY-97110TL-PT SESSION BY LICENSED PT 23 244.500000 19049.7000 77.9129
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 17 214.000000 17074.1400 79.7857
Subtotal (Total Children Is Unduplicated) 298 3724.500000 214612.1000 57.6217
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Total 6317.000000 321922.1500 50.9612
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Number of Children (Unduplicated) With at Least One Service 528
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Center 52
Flag Claims Units Chgs Paid
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R 170 157.750000 6045.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 693 666.750000 32009.6500 162.0000
P 5737 5492.500000 283866.9000 283086.5500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6600 6317.000000 321922.1500 283248.5500