CMS/EIP Fiscal Report Center: 52
Services beginning 04/01/2025 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 156 362.000000 13475.7000 37.2257
Subtotal (Total Children Is Unduplicated) 156 362.000000 13475.7000 37.2257
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
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 4 8.000000 647.8400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 21 64.000000 4401.3100 68.7705
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 426.500000 23031.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 10 63.000000 3402.0000 54.0000
OCCT-97530TLGO-OT SESSION BY LICENSED OT 10 37.500000 3090.1600 82.4043
PHY-97110TL-PT SESSION BY LICENSED PT 8 27.250000 2215.9700 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 12 65.500000 5326.4600 81.3200
Subtotal (Total Children Is Unduplicated) 108 619.750000 37065.5900 59.8073
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Total 1045.750000 54942.6000 52.5389
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Number of Children (Unduplicated) With at Least One Service 187
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Center 52
Flag Claims Units Chgs Paid
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R 166 156.000000 5989.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 404 367.000000 18277.2800 162.0000
P 516 522.750000 30675.5200 30600.3100
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 1086 1045.750000 54942.6000 30762.3100