CMS/EIP Fiscal Report Center: 54
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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 23.7600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.500000 1859.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 20 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 49 102.000000 5749.4400 56.3671
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 917.4000 917.4000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 97 408.750000 20437.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 39 71.250000 3562.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 9 25.000000 1799.0000 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 98.000000 7052.0800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 8.000000 575.6800 71.9600
TRAV-TRAVS-Travel by mile 1 10.000000 4.4500 0.4450
Subtotal (Total Children Is Unduplicated) 136 622.000000 34348.6100 55.2228
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Total 724.000000 40098.0500 55.3840
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Number of Children (Unduplicated) With at Least One Service 165
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Center 54
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 0 0.000000 0.0000 0.0000
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 662 703.590000 38965.0200 38965.0200
29 20.410000 1133.0300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 691 724.000000 40098.0500 38965.0200