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
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-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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 32.000000 2400.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 21.000000 1650.0000 78.5714
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 18.000000 1350.0000 75.0000
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) 96 178.000000 10821.1100 60.7928
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EI Services,Class #03
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) 192 1665.000000 113314.6200 68.0568
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Total 1843.000000 124135.7300 67.3553
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Number of Children (Unduplicated) With at Least One Service 246
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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 1801 1839.000000 123847.8900 123847.8900
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
4 4.000000 287.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1805 1843.000000 124135.7300 123847.8900