CMS/EIP Fiscal Report Center: 55
Services beginning 07/01/2024 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.114267 458.5700 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 923.9200 76.9933
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.114267 458.5700 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 31 33.527450 1908.7500 56.9310
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 3.907995 221.0100 56.5533
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 8.571484 512.1700 59.7528
PSTF-97164-PT RE-EVAL EST PLAN CARE 17 16.365887 930.8500 56.8775
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 1.831842 101.3800 55.3432
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.490105 654.2900 56.9438
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 74 116.923297 7398.1200 63.2733
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 37.000000 1962.0000 53.0270
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 3.000000 162.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 425.244392 33475.7500 78.7212
OCCT-97530GT-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 44 633.524941 40127.9900 63.3408
PHY-97110-PT SESSION BY LICENSED PT 28 257.049382 20385.2800 79.3049
PHY-97110HM-PT SESSION BY PT ASST 25 392.944219 24708.9492 62.8816
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 80 933.935878 73375.2600 78.5656
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 22.500000 1820.3400 80.9040
Subtotal (Total Children Is Unduplicated) 177 2709.198812 196342.8492 72.4727
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Total 2826.122109 203740.9692 72.0921
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Number of Children (Unduplicated) With at Least One Service 187
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Center 55
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 1762 1702.298192 124237.0200 124237.0200
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 84 80.250000 5566.3900 5566.3900
1341 1043.573917 73937.5592 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3187 2826.122109 203740.9692 129803.4100