CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 1
List order: No List
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
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 8 8.000000 155.9800 19.4975
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 114.5100 14.3138
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.7000 23.7000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 76.1900 9.5238
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 9.000000 265.1300 29.4589
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 6 6.000000 128.3600 21.3933
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.500000 187.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 41.000000 3075.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 84 188.000000 14100.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 34 80.500000 6037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 7.500000 562.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 32.000000 2400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 40.000000 2220.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 76 163.000000 9046.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 15.500000 1162.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 60.500000 4537.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 2.000000 51.0500 25.5250
Subtotal (Total Children Is Unduplicated) 165 707.000000 46184.1700 65.3241
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 11.000000 3391.5500 308.3227
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 303.000000 15150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 54 318.750000 15937.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 110 474.750000 31645.3000 66.6568
OCCT-97530GT-OT SESSION BY LICENSED OT 30 94.000000 6576.6600 69.9645
OCCT-97530HM-OT SESSION BY OT ASST 13 81.250000 4248.8200 52.2932
OCCT-97530HMGT-OT SESSION BY OT ASST 2 14.750000 843.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 135 688.250000 48146.3900 69.9548
PHY-97110GT-PT SESSION BY LICENSED PT 47 165.000000 11099.5400 67.2699
SENS-V5264-EARMOLD 3 7.000000 126.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 163 722.250000 50573.7200 70.0225
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 85 393.500000 27855.1400 70.7882
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 1 0.500000 6.9400 13.8800
Subtotal (Total Children Is Unduplicated) 433 3276.000000 215715.6600 65.8473
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Total 3983.000000 261899.8300 65.7544
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Number of Children (Unduplicated) With at Least One Service 548
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Center 10
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 1304 2566.250000 165879.0100 165879.0100
D 0 0.000000 0.0000 0.0000
S 21 31.500000 1361.6800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
731 1385.250000 94659.1400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2056 3983.000000 261899.8300 165879.0100