CMS/EIP Fiscal Report Center: 07
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 10.250000 381.3000 37.2000
Subtotal (Total Children Is Unduplicated) 14 10.250000 381.3000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 61.7100 61.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 64.6000 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 4 8.000000 194.2400 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 19.000000 155.8200 8.2011
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 15 15.000000 462.7000 30.8467
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 44.1900 14.7300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 773.9200 77.3920
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 635.8800 79.4850
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 4.898300 384.7043 78.5383
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 40.634500 3118.1311 76.7361
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1073.9200 76.7086
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 39.006400 3003.2582 76.9940
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 17.013500 1329.9132 78.1681
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 14.556100 1112.6907 76.4415
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.047200 690.5000 76.3220
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 28.173200 2254.8057 80.0337
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.776000 1286.7605 76.7025
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 12.000000 697.3200 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 225.7400 56.4350
OCTH-97166-OT EVAL MODERATE COMPLEXITY 18 18.000000 1025.8800 56.9933
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 341.9600 56.9933
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
PSTF-97164-PT RE-EVAL EST PLAN CARE 11 14.000000 793.4400 56.6743
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 160.9300 53.6433
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 219.0400 54.7600
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 502.8900 55.8767
SPCH-92521-EVAL OF SPEECH FLUENCY 6 6.000000 328.5600 54.7600
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 57 65.000000 3636.4500 55.9454
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 277.1500 55.4300
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 130.000000 7373.4000 56.7185
Subtotal (Total Children Is Unduplicated) 219 548.105200 33613.5137 61.3268
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 3994.7300 1997.3650
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 2.500000 150.0000 60.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 859.750000 45322.5000 52.7159
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 9 18.500000 975.0000 52.7027
OCCT-97530-OT SESSION BY LICENSED OT 72 980.750000 76982.5700 78.4936
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 73.5200 73.5200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 7.000000 569.2400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 49.500000 3964.5000 80.0909
OCCT-97530HM-OT SESSION BY OT ASST 11 81.000000 5079.3600 62.7081
OCCT-97530HMGT-OT SESSION BY OT ASST 3 3.000000 195.3600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 57 880.750000 68654.5700 77.9501
PHY-97110GT-PT SESSION BY LICENSED PT 7 28.000000 2164.6400 77.3086
SENS-V5264-EARMOLD 5 15.000000 271.9500 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 151 2183.500000 170336.1500 78.0106
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 42.000000 3228.2400 76.8629
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 102.000000 6604.6400 64.7514
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 6 40.000000 2574.7200 64.3680
Subtotal (Total Children Is Unduplicated) 283 5296.250000 391141.6900 73.8526
-----------------------------------------------------------------------------------------------------------------------
Total 5854.605200 425136.5037 72.6157
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 376
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 5723 5727.855200 416054.6137 415803.7500
D 33 60.000000 4562.5500 0.0000
S 0 0.000000 0.0000 0.0000
H 11 19.000000 1479.8400 0.0000
T 0 0.000000 0.0000 0.0000
50 48.750000 3292.9700 58.1100
Other 4 -1.000000 -253.4700 -253.4700
---------------------------------------------------------
Total 5821 5854.605200 425136.5037 415608.3900