CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
Subtotal (Total Children Is Unduplicated) 4 6.000000 154.9000 25.8167
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 47.3500 47.3500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 74.000000 3700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 16.000000 800.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 30.000000 1813.2500 60.4417
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 23.000000 1511.1600 65.7026
OCCT-97530HM-OT SESSION BY OT ASST 1 1.500000 86.4000 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 8.250000 497.0900 60.2533
PHY-97110-PT SESSION BY LICENSED PT 16 158.500000 9551.8800 60.2642
PHY-97110GT-PT SESSION BY LICENSED PT 5 29.500000 1672.8700 56.7075
PHY-97110HM-PT SESSION BY PT ASST 5 37.000000 2034.7600 54.9935
PHY-97110HMGT-PT SESSION BY PT ASST 3 11.000000 643.9600 58.5418
SENS-V5264-EARMOLD 3 5.000000 90.6500 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 232.750000 15259.0900 65.5600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 96.750000 6614.5400 68.3673
Subtotal (Total Children Is Unduplicated) 98 728.250000 44610.8400 61.2576
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Total 734.250000 44765.7400 60.9680
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Number of Children (Unduplicated) With at Least One Service 99
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Center 06
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 601 558.000000 33405.0500 33405.0500
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 0 0.000000 0.0000 0.0000
207 176.250000 11360.6900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 808 734.250000 44765.7400 33405.0500