CMS/EIP Fiscal Report Center: 57
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-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.1900 15.1900
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-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.500000 569.2400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 10 18.500000 901.4800 48.7286
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 37.000000 1998.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 57.500000 4675.9000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 3 16.000000 1041.9200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 325.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 24 123.500000 8691.9800 70.3804
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Total 142.000000 9593.4600 67.5596
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Number of Children (Unduplicated) With at Least One Service 30
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Center 57
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 0 0.000000 0.0000 0.0000
D 4 4.000000 325.2800 0.0000
S 0 0.000000 0.0000 0.0000
H 5 5.000000 99.8000 0.0000
T 21 22.000000 1642.0300 1642.0300
108 111.000000 7526.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 138 142.000000 9593.4600 1642.0300