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: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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 22.000000 1595.6800 72.5309
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 10.000000 647.8400 64.7840
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 45.000000 2996.7600 66.5947
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 42.000000 2984.8000 71.0667
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2126.6800 55.9653
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 3.000000 109.5200 36.5067
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 13 13.000000 681.8400 52.4492
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 20.000000 882.8600 44.1430
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 52.000000 2295.4100 44.1425
Subtotal (Total Children Is Unduplicated) 77 257.000000 15063.3500 58.6123
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 117 1467.750000 77410.5400 52.7410
OCCT-97530-OT SESSION BY LICENSED OT 19 125.500000 8087.3000 64.4406
OCCT-97530GO-OT SESSION BY LICENSED OT 11 111.000000 6765.2000 60.9477
PHY-97110-PT SESSION BY LICENSED PT 20 129.500000 9983.0200 77.0890
PHY-97110HM-PT SESSION BY PT ASST 10 121.000000 7442.1200 61.5051
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 629.000000 40946.8200 65.0983
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 202 2584.750000 150706.9600 58.3062
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Total 2841.750000 165770.3100 58.3339
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Number of Children (Unduplicated) With at Least One Service 239
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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 2152 2211.750000 126345.0800 126345.0800
620 630.000000 39425.2300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2772 2841.750000 165770.3100 126345.0800