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:OTHER
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
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 61.7100 61.7100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 47.5200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 5.000000 159.0500 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 30.3800 15.1900
AUDE-V5010-ASSESSMENT FOR HEARING AID 6 8.000000 274.4400 34.3050
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
Subtotal (Total Children Is Unduplicated) 7 23.000000 688.9100 29.9526
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 2 3.000000 208.0500 69.3500
AUDE-V5160-DISPENSING FEE BINAURAL 2 2.000000 461.2400 230.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 10.000000 500.0000 50.0000
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 7 18.000000 344.4700 19.1372
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 15 36.500000 2119.9400 58.0805
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Total 59.500000 2808.8500 47.2076
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Number of Children (Unduplicated) With at Least One Service 16
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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
54 59.500000 2808.8500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 54 59.500000 2808.8500 0.0000