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
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 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.8100 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 514.1000 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 7 7.000000 359.8700 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 18 18.000000 925.3800 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
Subtotal (Total Children Is Unduplicated) 46 51.000000 2457.8200 48.1925
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 693 4867.750000 243437.5000 50.0103
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 354 1844.250000 92212.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 186 836.250000 60176.5500 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 8 20.000000 1439.2000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 53 218.500000 12608.0000 57.7025
OCCT-97530HMGT-OT SESSION BY OT ASST 2 3.000000 172.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 226 793.750000 57118.2500 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 5 7.000000 503.7200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 16 74.000000 4259.4400 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 18.500000 1064.8600 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 287 1507.250000 108461.7100 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 39.750000 2860.4100 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 11.500000 662.4000 57.6000
Subtotal (Total Children Is Unduplicated) 1263 10245.50000 585077.3400 57.1058
-----------------------------------------------------------------------------------------------------------------------
Total 10296.500000 587535.1600 57.0616
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1271
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 11 15.000000 780.4000 132.0000
D 1 1.000000 50.0000 0.0000
S 18 30.750000 1754.0100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4866 10249.750000 584950.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4896 10296.500000 587535.1600 132.0000