CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 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-V5090-DISPENSING FEE PER HEARING AID 1 3.000000 347.4300 115.8100
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 809.8000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.500000 509.3200 59.9200
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 51.000000 2963.6100 58.1100
Subtotal (Total Children Is Unduplicated) 17 75.500000 4850.2300 64.2415
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 54.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 25 121.000000 6264.0000 51.7686
OCCT-97530-OT SESSION BY LICENSED OT 60 283.750000 23074.5500 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 6.750000 548.9100 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 7 38.000000 2474.5600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 82 512.250000 41656.1700 81.3200
PHY-97110GP-PT SESSION BY LICENSED PT 1 2.250000 182.9700 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 11.000000 716.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 98 538.750000 42911.1300 79.6494
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 196 1520.750000 118370.5300 77.8369
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Total 1596.250000 123220.7600 77.1939
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Number of Children (Unduplicated) With at Least One Service 203
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Center 09
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 1265 1228.750000 94316.5400 94316.5400
D 13 13.000000 661.8400 0.0000
S 1 2.000000 161.9600 0.0000
H 0 0.000000 0.0000 0.0000
T 200 201.500000 16248.0200 16248.0200
158 151.000000 11832.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1637 1596.250000 123220.7600 110564.5600