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:TPIN
Eligibility Filter:Program Patients
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 36.500000 2955.7700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 7.500000 566.8600 75.5813
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 11.500000 931.2700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 18.500000 1108.5200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 204 429.500000 34740.4200 80.8857
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 92.000000 7450.1600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 45 94.000000 7571.6300 80.5493
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 169 347.500000 20822.2000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 95.000000 7693.1000 80.9800
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) 310 1295.000000 93122.1300 71.9090
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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 3885.000000 297062.8900 76.4641
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Number of Children (Unduplicated) With at Least One Service 601
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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
2016 1982.000000 148057.6800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4962 3885.000000 297062.8900 148761.2500