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
Payclass Filters:MED
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 1 1.000000 21.4600 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
OCTH-97165-OT EVAL LOW COMPLEXITY 5 5.000000 290.5500 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 464.8800 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 12 12.000000 697.3200 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 13 78.000000 4532.5800 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 39 115.000000 6492.5800 56.4572
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 723 5443.250000 293935.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 215 895.000000 48288.0000 53.9531
OCCT-97530-OT SESSION BY LICENSED OT 116 618.000000 50195.4100 81.2223
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.500000 284.6200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 16 58.000000 3776.9600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 171 640.000000 52044.8000 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 4.000000 325.2800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 20 116.500000 7586.4800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 163 821.750000 66824.7100 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 15.000000 1219.8000 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 19.000000 1209.2400 63.6442
Subtotal (Total Children Is Unduplicated) 1106 8634.000000 525690.8000 60.8861
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Total 8749.000000 532183.3800 60.8279
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Number of Children (Unduplicated) With at Least One Service 1111
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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 3 3.000000 162.0000 162.0000
D 1 1.000000 54.0000 0.0000
S 1 1.000000 65.1200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9889 8744.000000 531902.2600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9894 8749.000000 532183.3800 162.0000