CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 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-92550-TYMPANOMETRY & REFLEX THRESH 3 3.000000 47.5200 15.8400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 29.3600 14.6800
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 8.8100 8.8100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 10.000000 88.1000 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 12.000000 347.0400 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 55.2400 13.8100
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 2 2.000000 150.2600 75.1300
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 37.000000 2775.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
Subtotal (Total Children Is Unduplicated) 61 126.000000 7168.0800 56.8895
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2501.6000 1250.8000
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 61 598.000000 29900.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 33 76.500000 3825.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 7 12.000000 180.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 396.456910 28529.0400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 15 39.000000 2806.4400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 359.4200 359.4200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 53.000000 3813.8800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 112 1184.956910 72471.1000 61.1593
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Total 1310.956910 79639.1800 60.7489
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Number of Children (Unduplicated) With at Least One Service 154
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Center 53
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 909 910.515717 52146.2509 47305.2700
384 400.441193 27492.9291 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1293 1310.956910 79639.1800 47305.2700