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: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-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) 3 3.000000 23.7600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 46.2800 23.1400
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 348.6600 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 348.6600 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 22 24.000000 1394.6400 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 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 19 98.000000 5601.7700 57.1609
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 56 153.000000 8472.4000 55.3752
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 1436.5200 718.2600
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 25.000000 1350.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 141 592.750000 47170.6300 79.5793
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 0.500000 40.6600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 18 86.250000 5456.6000 63.2649
PHY-97110-PT SESSION BY LICENSED PT 173 735.000000 57989.3500 78.8971
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 4 25.000000 1628.0000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 219 1069.000000 84745.1800 79.2752
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 38.000000 3090.1600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 15.000000 911.6800 60.7787
Subtotal (Total Children Is Unduplicated) 351 2590.000000 203940.7600 78.7416
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Total 2743.000000 212413.1600 77.4383
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Number of Children (Unduplicated) With at Least One Service 362
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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 2940 1900.000000 148761.2500 148761.2500
D 2 1.000000 81.3200 0.0000
S 4 2.000000 162.6400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1463 840.000000 63407.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4409 2743.000000 212413.1600 148761.2500