CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.250000 9.3000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 10 68.000000 2529.6000 37.2000
Subtotal (Total Children Is Unduplicated) 10 68.250000 2538.9000 37.2000
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 15.8400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.000000 233.9700 77.9900
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 230.9800 76.9933
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 230.9800 76.9933
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.500000 200.8800 57.3943
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 25.500000 1936.4200 75.9380
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 44.000000 3326.9100 75.6116
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 32.000000 2423.9200 75.7475
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 24 44.000000 3326.9100 75.6116
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 22.500000 1688.1500 75.0289
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 30.000000 1678.2600 55.9420
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 28 51.500000 2932.6100 56.9439
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 91 292.500000 19853.6300 67.8757
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 47.3500 47.3500
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 342.500000 18199.0000 53.1358
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 48.000000 2548.0000 53.0833
OCCT-97530-OT SESSION BY LICENSED OT 11 104.250000 6823.9400 65.4575
OCCT-97530GO-OT SESSION BY LICENSED OT 2 3.500000 265.9000 75.9714
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 7.750000 306.5600 39.5561
OCCT-97530GT-OT SESSION BY LICENSED OT 6 86.500000 6003.2200 69.4014
OCCT-97530HM-OT SESSION BY OT ASST 2 21.500000 1291.1200 60.0521
OCCT-97530HMGT-OT SESSION BY OT ASST 3 23.250000 1457.6100 62.6929
PHY-97110-PT SESSION BY LICENSED PT 17 480.250000 33654.5800 70.0772
PHY-97110GT-PT SESSION BY LICENSED PT 6 39.250000 2407.7300 61.3434
PHY-97110HM-PT SESSION BY PT ASST 8 100.500000 5805.7200 57.7684
PHY-97110HMGT-PT SESSION BY PT ASST 3 19.750000 803.2800 40.6724
SENS-V5264-EARMOLD 4 9.000000 163.1700 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 524.500000 38870.2200 74.1091
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 27 241.000000 17970.6700 74.5671
Subtotal (Total Children Is Unduplicated) 109 2053.500000 136643.0700 66.5415
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Total 2414.250000 159035.6000 65.8737
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Number of Children (Unduplicated) With at Least One Service 186
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Center 06
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 1505 1411.250000 91738.3000 91738.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1016 1003.000000 67297.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2521 2414.250000 159035.6000 91738.3000