CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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 3 3.000000 70.5000 23.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 43.7400 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 29.3700 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 86.1600 28.7200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 62.6700 20.8900
OCTH-97166-OT EVAL MODERATE COMPLEXITY 22 22.000000 1123.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 10 10.000000 510.5000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 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 19 19.000000 969.9500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 52 71.000000 3151.2400 44.3837
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 553 5454.000000 272700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 379 2313.250000 115662.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 186 1097.500000 78405.4000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 9 46.750000 3339.8200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 60 310.250000 17746.3000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 3.500000 200.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 277 1425.000000 101802.0000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 21 51.250000 3661.3000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 11 20.000000 1143.2000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 239 1312.500000 93592.3200 71.3084
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 36 133.500000 9537.2400 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 6.000000 343.2000 57.2000
SPL-92508HA-GROUP SPL SESSION PER CHILD 2 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 1226 12177.50000 698189.0000 57.3343
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Total 12248.500000 701340.2400 57.2593
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Number of Children (Unduplicated) With at Least One Service 1234
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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 1 4.000000 285.7600 0.0000
D 3 6.000000 428.6400 0.0000
S 15 24.500000 1168.9600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3949 12214.000000 699456.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3968 12248.500000 701340.2400 0.0000