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:EIP DEI DEIP
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 478 2215.500000 81849.3000 36.9439
Subtotal (Total Children Is Unduplicated) 478 2215.500000 81849.3000 36.9439
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 971.7600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 773.9200 77.3920
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 14 28.000000 1660.0800 59.2886
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 26 51.000000 3932.6400 77.1106
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 20 40.000000 3083.7200 77.0930
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 26.000000 2057.6400 79.1400
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 62 123.500000 7048.7300 57.0747
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 5 10.000000 750.0000 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 7.000000 406.7700 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 3.000000 188.1800 62.7267
Subtotal (Total Children Is Unduplicated) 122 364.500000 24176.3400 66.3274
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 235 2678.500000 140801.0000 52.5671
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 28 394.000000 20816.0000 52.8325
OCCT-97530-OT SESSION BY LICENSED OT 15 45.000000 3175.9200 70.5760
OCCT-97530GO-OT SESSION BY LICENSED OT 2 3.000000 71.2400 23.7467
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 25 212.000000 17032.4600 80.3418
OCCT-97530TLHM-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 4 6.000000 339.8400 56.6400
PHY-97110TL-PT SESSION BY LICENSED PT 23 244.500000 19049.7000 77.9129
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 17 230.500000 18456.5800 80.0719
Subtotal (Total Children Is Unduplicated) 299 3819.500000 220188.9000 57.6486
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Total 6399.500000 326214.5400 50.9750
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Number of Children (Unduplicated) With at Least One Service 509
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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 682 645.500000 31049.5500 162.0000
P 5652 5364.500000 277561.6400 276893.7900
D 0 0.000000 0.0000 0.0000
S 52 63.250000 3152.0600 701.8800
H 4 4.250000 174.9000 0.0000
T 1 2.000000 150.0000 146.9600
113 119.750000 5829.5400 0.0000
Other 41 42.500000 2251.2500 2036.1500
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Total 6715 6399.500000 326214.5400 279940.7800