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:TPIN
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 13 26.000000 967.2000 37.2000
Subtotal (Total Children Is Unduplicated) 13 26.000000 967.2000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 14.000000 921.0800 65.7914
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 8.000000 293.9200 36.7400
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 473.9200 78.9867
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 14.000000 821.2000 58.6571
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 39.500000 2986.4200 75.6056
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1061.9600 75.8543
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 30.000000 1860.5000 62.0167
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 311.9600 77.9900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 47.000000 2617.3400 55.6881
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
SCREEN-T1023-SCREENING 5 5.000000 265.9200 53.1840
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 12.000000 619.0200 51.5850
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 134.000000 6837.4500 51.0257
Subtotal (Total Children Is Unduplicated) 70 342.500000 20009.9000 58.4231
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 0.500000 25.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 127 1444.750000 76015.0000 52.6146
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 73.000000 3798.0000 52.0274
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 144.000000 10953.4200 76.0654
OCCT-97530GO-OT SESSION BY LICENSED OT 7 27.000000 1585.0600 58.7059
OCCT-97530HM-OT SESSION BY OT ASST 1 6.000000 390.7200 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 5.000000 387.8800 77.5760
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 8.000000 631.8400 78.9800
PHY-97110-PT SESSION BY LICENSED PT 29 358.750000 24775.1200 69.0596
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 60.0000 30.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 482.500000 33110.2700 68.6223
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 40.6600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 397.2400 79.4480
Subtotal (Total Children Is Unduplicated) 202 2559.000000 152232.2100 59.4889
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Total 2927.500000 173209.3100 59.1663
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Number of Children (Unduplicated) With at Least One Service 231
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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 370 386.750000 24960.8100 20909.9800
D 211 220.000000 16103.7200 15.0000
S 0 0.000000 0.0000 0.0000
H 105 110.000000 8629.3900 0.0000
T 1893 1876.500000 105856.9000 77305.9000
305 332.250000 17618.4900 0.0000
Other 2 2.000000 40.0000 40.0000
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Total 2886 2927.500000 173209.3100 98270.8800