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
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 7 11.000000 734.3100 66.7555
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 47 234.250000 12622.5000 53.8847
OCCT-97530GO-OT SESSION BY LICENSED OT 8 46.000000 2927.5200 63.6417
PHY-97110-PT SESSION BY LICENSED PT 5 12.500000 1016.5000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 3 9.000000 586.0800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 87.250000 6139.6600 70.3686
Subtotal (Total Children Is Unduplicated) 74 389.000000 23292.2600 59.8773
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Total 400.000000 24026.5700 60.0664
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Number of Children (Unduplicated) With at Least One Service 78
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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 302 299.000000 16796.3100 16796.3100
101 101.000000 7230.2600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 403 400.000000 24026.5700 16796.3100