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: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 2 2.000000 74.4000 37.2000
Subtotal (Total Children Is Unduplicated) 2 2.000000 74.4000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 4.000000 146.9600 36.7400
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 109.4300 36.4767
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 26.000000 1557.2800 59.8954
Subtotal (Total Children Is Unduplicated) 13 44.000000 2551.6000 57.9909
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 46 287.500000 15525.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 10.000000 540.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 23.000000 1870.3600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 4 13.000000 795.3200 61.1785
OCCT-97530HM-OT SESSION BY OT ASST 1 6.000000 390.7200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 10 36.500000 2634.2200 72.1704
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 102.250000 8092.3300 79.1426
Subtotal (Total Children Is Unduplicated) 74 478.250000 29847.9500 62.4108
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Total 524.250000 32473.9500 61.9436
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Number of Children (Unduplicated) With at Least One Service 81
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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 42 43.000000 2834.9300 1682.5100
D 8 8.000000 650.5600 0.0000
S 0 0.000000 0.0000 0.0000
H 49 47.000000 3781.9500 0.0000
T 379 376.250000 22214.4600 16024.3800
50 50.000000 2992.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 528 524.250000 32473.9500 17706.8900