CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 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 1028 7506.750000 279139.5000 37.1851
Subtotal (Total Children Is Unduplicated) 1028 7506.750000 279139.5000 37.1851
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 4.000000 467.3200 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 337.0200 112.3400
AACIS-92597TLGT-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 433.4300 78.8055
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 23.000000 1862.5400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 29.500000 2278.0300 77.2214
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 20 38.500000 3037.0000 78.8831
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.000000 704.9000 78.3222
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 40.000000 2343.7600 58.5940
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.500000 931.2700 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 15.500000 1204.3600 77.7006
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 36 71.500000 5565.8200 77.8436
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 66.000000 5192.1900 78.6695
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 66 124.000000 9622.9200 77.6042
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.000000 836.9600 76.0873
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 30.000000 2291.8600 76.3953
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 19.000000 1120.8000 58.9895
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 60 116.500000 6684.5400 57.3780
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 100.000000 7691.3600 76.9136
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 47.500000 3682.1000 77.5179
Subtotal (Total Children Is Unduplicated) 327 774.000000 57010.7300 73.6573
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 8 8.000000 377.9900 47.2488
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 191.7600 47.9400
AACFIT-92609TLGT-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 119 1061.500000 55901.0000 52.6623
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 62 266.500000 13963.0000 52.3940
OCCT-97530-OT SESSION BY LICENSED OT 7 7.000000 541.1600 77.3086
OCCT-97530GO-OT SESSION BY LICENSED OT 3 5.000000 387.8800 77.5760
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 9.000000 525.9200 58.4356
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 62 217.750000 15697.3700 72.0890
OCCT-97530TLGO-OT SESSION BY LICENSED OT 110 1069.000000 84913.7700 79.4329
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 36 88.750000 7048.6700 79.4216
OCCT-97530TLGT-OT SESSION BY LICENSED OT 12 16.000000 1170.0800 73.1300
OCCT-97530TLGTHM-OT SESSION BY OT ASST 7 13.000000 846.5600 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 13 108.750000 7081.8000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 315.9200 78.9800
PHY-97110TL-PT SESSION BY LICENSED PT 52 536.500000 41824.0400 77.9572
PHY-97110TLGT-PT SESSION BY LICENSED PT 17 40.250000 3114.0100 77.3667
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 10.000000 803.8400 80.3840
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 48 335.750000 26367.1900 78.5322
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 18 48.250000 3685.0100 76.3733
Subtotal (Total Children Is Unduplicated) 349 3853.000000 265015.7900 68.7817
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Total 12133.750000 601166.0200 49.5449
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Number of Children (Unduplicated) With at Least One Service 1034
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Center 54
Flag Claims Units Chgs Paid
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R 7 9.500000 441.6400 55.8000
U 0 0.000000 0.0000 0.0000
B 1637 1473.500000 74987.2500 46212.3000
P 11833 10650.750000 525737.1300 525233.0400
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 13477 12133.750000 601166.0200 571501.1400