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
Agency Filter:EXT
Payclass Filters:MED
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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
Subtotal (Total Children Is Unduplicated) 1 1.000000 7.9200 7.9200
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 69.3500 69.3500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 618 11273.00000 597005.6000 52.9589
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 172 1895.250000 99788.5000 52.6519
OCCT-97530-OT SESSION BY LICENSED OT 2 10.000000 747.6800 74.7680
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 3.000000 234.6000 78.2000
OCCT-97530GT-OT SESSION BY LICENSED OT 2 6.000000 450.4800 75.0800
OCCT-97530HMGT-OT SESSION BY OT ASST 1 6.500000 413.2400 63.5754
PHY-97110-PT SESSION BY LICENSED PT 10 197.250000 15247.8300 77.3021
PHY-97110GT-PT SESSION BY LICENSED PT 2 9.250000 752.2100 81.3200
PHY-97110HM-PT SESSION BY PT ASST 9 141.750000 8859.1600 62.4985
PHY-97110HMGT-PT SESSION BY PT ASST 4 71.000000 4369.4000 61.5408
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 62.000000 4681.2000 75.5032
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 44.500000 3387.0800 76.1142
Subtotal (Total Children Is Unduplicated) 707 13722.50000 736168.9700 53.6469
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Total 13723.500000 736176.8900 53.6435
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Number of Children (Unduplicated) With at Least One Service 707
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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 0 0.000000 0.0000 0.0000
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
13726 13723.500000 736176.8900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13726 13723.500000 736176.8900 0.0000