CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2025 ending 03/31/2025 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 3 3.000000 64.3800 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 48.4500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 39.6000 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 4.000000 92.5600 23.1400
EXIT-EXIT-COS Exit 33 36.000000 1800.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 581.1000 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 639.2100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 17 17.000000 987.8700 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 35 37.000000 2150.0700 58.1100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 38 226.000000 13039.8500 57.6985
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 139 366.000000 20177.7300 55.1304
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 4355.6600 1088.9150
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 31.500000 1575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 182 157.000000 7875.0000 50.1592
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 42 57.000000 2850.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 164 276.000000 13800.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 25.000000 1250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 24 45.000000 2250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 14 17.000000 850.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 24.500000 1225.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 156 261.000000 13050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1177 8736.250000 471757.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 347 1377.000000 74316.0000 53.9695
EPIC-99601-Early Steps Professional Development Fee 483 3750.000000 56250.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1015 9022.000000 108286.4700 12.0025
OCCT-97530-OT SESSION BY LICENSED OT 277 1349.500000 108431.9300 80.3497
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.000000 325.2800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 39 164.750000 10568.5200 64.1488
PHY-97110-PT SESSION BY LICENSED PT 371 1557.500000 124875.0500 80.1766
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.500000 365.9400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 27 153.000000 9963.3600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 418 2149.250000 172467.3300 80.2454
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 66.000000 5367.1200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 38.000000 2381.4000 62.6684
Subtotal (Total Children Is Unduplicated) 1918 29284.00000 1194949.1300 40.8055
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Total 29650.000000 1215126.8600 40.9824
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Number of Children (Unduplicated) With at Least One Service 1923
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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 21399 19997.500000 616154.5900 616151.1600
D 4 3.000000 147.3200 0.0000
S 15 11.500000 598.7400 149.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11406 9638.000000 598226.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 32824 29650.000000 1215126.8600 616300.1600