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
Agency Filter:EXT
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 22 23.000000 493.5800 21.4600
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 26.0400 26.0400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 22 23.000000 371.4500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.2300 23.2300
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 23 24.000000 190.0800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 22 24.000000 731.6300 30.4846
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 22 23.000000 563.1300 24.4839
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 5.000000 181.2800 36.2560
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 5.000000 579.0500 115.8100
EXIT-EXIT-COS Exit 15 15.250000 762.5000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 16 16.000000 822.5600 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 17 22.000000 880.6700 40.0305
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 13.3500 13.3500
PSTH-97161-PT EVAL LOW COMPLEXITY 20 20.000000 1028.2000 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 51 52.000000 2619.9700 50.3840
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 10.000000 462.6900 46.2690
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 36.000000 1583.4700 43.9853
Subtotal (Total Children Is Unduplicated) 142 302.250000 11384.2900 37.6651
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2592.0000 1296.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 43 37.000000 1850.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 220 181.250000 9062.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 10.250000 256.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 69 83.250000 4162.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 282 511.000000 25550.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 30.000000 1500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 26 43.500000 2200.0000 50.5747
CONOP-CONOP-CONSULT, OT, PHONE 2 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 18.000000 900.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 69 87.250000 4362.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 40.750000 2037.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 230 406.750000 20337.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 28.500000 1425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1268 12277.75000 614896.0000 50.0821
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 502 3234.500000 164287.0000 50.7921
EPIC-99601-Early Steps Professional Development Fee 567 5492.000000 82380.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1111 12806.00000 153663.0000 11.9993
OCCT-97530-OT SESSION BY LICENSED OT 392 2446.500000 173241.6700 70.8120
OCCT-97530GO-OT SESSION BY LICENSED OT 3 4.500000 337.8600 75.0800
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 3.500000 251.8600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 12.500000 899.5000 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 75 453.750000 25507.6300 56.2152
PHY-97110-PT SESSION BY LICENSED PT 471 2741.500000 193882.8800 70.7215
PHY-97110GT-PT SESSION BY LICENSED PT 6 12.000000 832.2200 69.3517
PHY-97110HM-PT SESSION BY PT ASST 30 185.500000 10709.9500 57.7356
SENS-V5050-IN EAR MONAURAL HEARING AID 4 4.000000 918.4400 229.6100
SENS-V5264-EARMOLD 5 6.000000 108.7800 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 585 3873.750000 273744.5400 70.6665
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 113.500000 8326.5800 73.3619
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 19.500000 905.4000 46.4308
Subtotal (Total Children Is Unduplicated) 2273 45174.75000 1781341.5600 39.4322
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Total 45477.000000 1792725.8500 39.4205
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Number of Children (Unduplicated) With at Least One Service 2276
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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 32789 30291.000000 915479.9600 915482.3100
D 25 25.000000 722.0400 0.0000
S 12 7.500000 338.2200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
18912 15153.500000 876185.6300 105.0000
Other 0 0.000000 0.0000 0.0000
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Total 51738 45477.000000 1792725.8500 915587.3100