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: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 15 16.000000 314.3900 19.6494
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 15 16.000000 232.5700 14.5356
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 15.000000 146.1400 9.7427
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 15.000000 430.9200 28.7280
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 13 14.000000 273.0800 19.5057
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 12.000000 561.5500 46.7958
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 1.500000 76.5700 51.0467
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 22 24.250000 1084.8000 44.7340
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 53 122.750000 3572.9700 29.1077
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 5.000000 50.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 144 750.750000 51935.4300 69.1781
OCCT-97530GT-OT SESSION BY LICENSED OT 8 37.250000 2661.1400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 29 178.000000 10215.1600 57.3885
PHY-97110-PT SESSION BY LICENSED PT 179 954.250000 65721.9300 68.8729
PHY-97110GT-PT SESSION BY LICENSED PT 16 52.000000 3589.8600 69.0358
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 211 1151.250000 80394.9800 69.8328
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 79.250000 5590.1800 70.5385
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 38.500000 2202.2000 57.2000
Subtotal (Total Children Is Unduplicated) 381 3257.250000 222910.8800 68.4353
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Total 3380.000000 226483.8500 67.0071
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Number of Children (Unduplicated) With at Least One Service 403
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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 1393 2199.750000 146605.8400 146415.8000
D 1 1.000000 71.4400 0.0000
S 8 11.000000 521.5300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
686 1168.250000 79285.0400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2088 3380.000000 226483.8500 146415.8000