CMS/EIP Fiscal Report Center: 10
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
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 13 13.000000 278.9800 21.4600
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 26.0400 26.0400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 13 13.000000 209.9500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.2300 23.2300
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.000000 110.8800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 14.000000 413.5300 29.5379
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 13 13.000000 331.7300 25.5177
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 4.000000 135.9600 33.9900
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 4.000000 463.2400 115.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 130 268.500000 20328.8600 75.7127
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 7.000000 525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 38.000000 2921.7600 76.8884
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 34.500000 2608.4300 75.6067
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 93 192.500000 10742.1900 55.8036
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 60.000000 4633.3000 77.2217
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 514.1000 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 16.000000 572.2100 35.7631
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 13.3500 13.3500
PSTH-97161-PT EVAL LOW COMPLEXITY 10 10.000000 514.1000 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 30 31.000000 1553.2100 50.1035
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 7.000000 308.4600 44.0657
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 24.000000 1053.9400 43.9142
Subtotal (Total Children Is Unduplicated) 219 809.500000 50451.1100 62.3238
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1596.0000 1596.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 9.000000 450.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 187 1160.500000 79861.0500 68.8161
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 3.500000 251.8600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 29 190.250000 10330.0300 54.2971
PHY-97110-PT SESSION BY LICENSED PT 204 1253.750000 85837.4700 68.4646
PHY-97110GT-PT SESSION BY LICENSED PT 2 6.000000 400.4600 66.7433
PHY-97110HM-PT SESSION BY PT ASST 7 69.000000 3975.4100 57.6146
SENS-V5050-IN EAR MONAURAL HEARING AID 3 3.000000 688.8300 229.6100
SENS-V5264-EARMOLD 4 5.000000 90.6500 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 306 1996.500000 138274.4100 69.2584
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 54.500000 3921.8200 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 19.500000 905.4000 46.4308
Subtotal (Total Children Is Unduplicated) 470 4776.500000 326943.1900 68.4483
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Total 5586.000000 377394.3000 67.5607
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Number of Children (Unduplicated) With at Least One Service 608
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Center 10
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 5117 3275.000000 220149.0200 220151.3700
D 18 18.000000 474.1200 0.0000
S 4 2.000000 143.9200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3330 2291.000000 156627.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8469 5586.000000 377394.3000 220151.3700