CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 31 58.250000 2166.9000 37.2000
Subtotal (Total Children Is Unduplicated) 31 58.250000 2166.9000 37.2000
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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) 2 2.000000 17.6200 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 63.000000 4725.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 31 58.000000 4320.7500 74.4957
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 18 34.000000 2550.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 81 154.500000 8574.7500 55.5000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 12.000000 600.0000 50.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 19 152.000000 7094.5800 46.6749
Subtotal (Total Children Is Unduplicated) 151 495.500000 28830.5000 58.1847
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 6 7.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 161.000000 8050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 85 417.500000 30043.3000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 9 11.000000 791.5600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 6 13.000000 748.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 101 827.250000 58016.9800 70.1323
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 221 1347.500000 96196.5200 71.3889
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 5.000000 359.8000 71.9600
Subtotal (Total Children Is Unduplicated) 373 2793.000000 194400.8800 69.6029
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Total 3346.750000 225398.2800 67.3484
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Number of Children (Unduplicated) With at Least One Service 500
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Center 09
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 3003 2955.250000 199673.1400 199601.1800
D 26 22.250000 1580.5600 0.0000
S 0 0.000000 0.0000 0.0000
H 155 266.000000 17446.7700 17446.7700
T 1 1.000000 0.0000 0.0000
107 100.250000 6547.8100 6547.8100
Other 1 2.000000 150.0000 150.0000
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Total 3293 3346.750000 225398.2800 223745.7600