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
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1360 3679.500000 136886.7000 37.2025
Subtotal (Total Children Is Unduplicated) 1360 3679.500000 136886.7000 37.2025
-----------------------------------------------------------------------------------------------------------------------
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
EXIT-EXIT-COS Exit 33 36.000000 1800.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 329.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 29 54.000000 4372.9200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.500000 850.2900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 850.2900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 53.000000 3205.7200 60.4853
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1093.2300 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 50.000000 2905.5000 58.1100
Subtotal (Total Children Is Unduplicated) 89 257.000000 16886.5200 65.7063
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2919.1400 1459.5700
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 444 3214.000000 173556.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 133 482.000000 26028.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 483 3750.000000 56250.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1016 9038.000000 108478.4700 12.0025
OCCT-97530-OT SESSION BY LICENSED OT 27 138.750000 11065.8900 79.7542
OCCT-97530HM-OT SESSION BY OT ASST 6 20.500000 1334.9600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 40 182.500000 14840.9000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 4 11.500000 748.8800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 258.500000 20897.4400 80.8412
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 13.000000 1057.1600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.000000 260.4800 65.1200
Subtotal (Total Children Is Unduplicated) 1562 18022.00000 462593.5700 25.6683
-----------------------------------------------------------------------------------------------------------------------
Total 21958.500000 616366.7900 28.0696
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2394
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 18472 18110.500000 467423.3400 467419.9100
D 2 1.750000 39.9000 0.0000
S 10 8.500000 370.9800 149.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4416 3836.750000 148495.3700 0.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 22901 21958.500000 616366.7900 467568.9100