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
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.500000 18.6000 37.2000
Subtotal (Total Children Is Unduplicated) 1 0.500000 18.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 959.8000 79.9833
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 36.000000 2795.6800 77.6578
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 3 3.000000 167.6300 55.8767
SCREEN-T1023-SCREENING 20 21.000000 1113.6800 53.0324
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 379.9700 54.2814
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 28.000000 1486.3800 53.0850
Subtotal (Total Children Is Unduplicated) 62 131.000000 8545.4300 65.2323
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 165 1609.500000 85042.0000 52.8375
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
OCCT-97530GO-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 14 60.000000 4373.7600 72.8960
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 23.000000 1870.3600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 17 149.000000 11751.6400 78.8701
PHY-97110TLHM-PT SESSION BY PT ASST 11 134.000000 8425.8400 62.8794
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 40.6600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 39 330.000000 25075.9200 75.9876
Subtotal (Total Children Is Unduplicated) 222 2313.000000 137101.9000 59.2745
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Total 2444.500000 145665.9300 59.5893
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Number of Children (Unduplicated) With at Least One Service 252
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Center 52
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 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
2423 2444.500000 145665.9300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2423 2444.500000 145665.9300 0.0000