CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Agency Filter:EXT
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 5 5.000000 97.5500 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.000000 73.4000 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 44.0500 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 144.6000 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 5.000000 105.2000 21.0400
EXIT-EXIT-COS Exit 1 0.750000 37.5000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 14 14.000000 719.7400 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 17 18.000000 873.9700 48.5539
PSTH-97161-PT EVAL LOW COMPLEXITY 11 11.000000 565.5100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 4.000000 143.9200 35.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 47 50.000000 2570.5000 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 6 6.000000 308.4600 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 514.1000 46.7364
Subtotal (Total Children Is Unduplicated) 107 139.750000 6198.5000 44.3542
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 6.000000 1419.1000 236.5167
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 49 47.250000 2362.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 265 234.000000 11700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 19 12.250000 306.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 57 85.000000 4250.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 238 354.500000 17725.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 29 39.750000 1987.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 8.750000 437.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 80 110.750000 5537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 37.000000 1850.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 141 205.750000 10287.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 4.000000 100.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.000000 150.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1097 8139.250000 407012.5000 50.0061
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 575 2966.000000 148300.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 349 2835.000000 42237.0000 14.8984
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1226 11459.00000 137508.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 400 1980.250000 139742.5400 70.5681
OCCT-97530GT-OT SESSION BY LICENSED OT 13 25.000000 1799.0000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 84 350.500000 20097.8500 57.3405
OCCT-97530HMGT-OT SESSION BY OT ASST 2 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 446 1848.250000 131382.3400 71.0847
PHY-97110GT-PT SESSION BY LICENSED PT 10 15.500000 1115.3800 71.9600
PHY-97110HM-PT SESSION BY PT ASST 24 117.000000 6734.5200 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 7 25.500000 1467.7800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 677 3853.000000 273488.3500 70.9806
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 43 115.250000 8293.3900 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 17.000000 979.2000 57.6000
Subtotal (Total Children Is Unduplicated) 2177 34917.50000 1379443.5000 39.5058
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Total 35057.250000 1385642.0000 39.5251
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Number of Children (Unduplicated) With at Least One Service 2184
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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 11392 23578.500000 719206.2300 718557.8300
D 11 15.500000 455.9000 0.0000
S 64 82.000000 3042.8800 100.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5723 11381.250000 662936.9900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17190 35057.250000 1385642.0000 718657.8300