CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 26 27.000000 526.7700 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 26 27.000000 396.3600 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 27 28.000000 201.6000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 25 26.000000 751.9200 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 26 27.000000 568.0800 21.0400
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 7 9.000000 359.8700 39.9856
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 0.500000 25.7050 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 14 13.000000 668.3225 51.4094
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 12.000000 514.1000 42.8417
Subtotal (Total Children Is Unduplicated) 62 178.500000 4475.4175 25.0724
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 2587.9200 646.9800
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 138 598.500000 41687.9800 69.6541
OCCT-97530GT-OT SESSION BY LICENSED OT 11 16.000000 1079.4000 67.4625
OCCT-97530HM-OT SESSION BY OT ASST 26 118.000000 5851.6400 49.5902
PHY-97110-PT SESSION BY LICENSED PT 139 510.250000 34630.7500 67.8702
PHY-97110GT-PT SESSION BY LICENSED PT 7 24.000000 1516.4300 63.1846
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 212 1013.500000 69645.3900 68.7177
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 18 58.000000 4173.6800 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 115.2000 57.6000
Subtotal (Total Children Is Unduplicated) 360 2349.250000 161538.3900 68.7617
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Total 2527.750000 166013.8075 65.6765
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Number of Children (Unduplicated) With at Least One Service 388
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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 1009 1633.250000 109387.8200 108698.3200
D 2 1.250000 89.9500 0.0000
S 18 18.000000 404.6200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
566 875.250000 56131.4175 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1595 2527.750000 166013.8075 108698.3200