CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 12 10.000000 372.0000 37.2000
Subtotal (Total Children Is Unduplicated) 12 10.000000 372.0000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.000000 48.5600 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 60.7800 8.6829
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 176.4100 29.4017
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 2.898300 222.7443 76.8534
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 50.634500 3808.3311 75.2122
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 31.259700 2352.0105 75.2410
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 26.556100 2000.7307 75.3398
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 7.575100 571.2893 75.4167
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 29.143100 2273.5482 78.0133
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 23.745900 1791.3830 75.4397
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 212.3400 53.0850
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 21.000000 1079.6100 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 27.000000 1388.0700 51.4100
Subtotal (Total Children Is Unduplicated) 144 302.812700 20241.1471 66.8438
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 2.500000 150.0000 60.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 45 275.000000 13758.0000 50.0291
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 6.000000 300.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 43 289.250000 20814.4300 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 6.500000 467.7400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 37 266.250000 19138.3500 71.8811
PHY-97110GT-PT SESSION BY LICENSED PT 5 12.000000 863.5200 71.9600
SENS-V5264-EARMOLD 1 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 100 777.000000 55942.4600 71.9980
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 20.000000 1439.2000 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 5.000000 288.0000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 4.000000 230.4000 57.6000
Subtotal (Total Children Is Unduplicated) 194 1667.500000 113464.6200 68.0448
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Total 1980.312700 134077.7671 67.7054
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Number of Children (Unduplicated) With at Least One Service 301
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Center 07
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 1816 1851.812700 124867.9271 124867.8700
D 32 64.000000 4800.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
35 38.500000 2459.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1896 1980.312700 134077.7671 124867.8700