CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 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-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.1900 15.1900
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 21.4600 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 11.000000 659.1200 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 522.9900 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 23 41.000000 2219.6200 54.1371
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 88.000000 4752.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 81.000000 6622.3000 81.7568
OCCT-97530HM-OT SESSION BY OT ASST 3 25.000000 1628.0000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 1 5.000000 406.6000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 23.000000 1497.7600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 6.000000 487.9200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 11.000000 894.5200 81.3200
Subtotal (Total Children Is Unduplicated) 31 239.000000 16289.1000 68.1552
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Total 280.000000 18508.7200 66.1026
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Number of Children (Unduplicated) With at Least One Service 48
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Center 57
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 26 18.657438 1393.1500 1195.9300
D 7 7.000000 569.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 5 5.000000 107.7500 0.0000
T 153 145.790341 10505.0400 10505.0400
105 103.552221 5933.5400 120.0000
Other 0 0.000000 0.0000 0.0000
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Total 296 280.000000 18508.7200 11820.9700