CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:MED
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 2011 10720.75000 398655.8000 37.1854
Subtotal (Total Children Is Unduplicated) 2011 10720.75000 398655.8000 37.1854
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 7 7.000000 150.2200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 113.0500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 63.3600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 222.6700 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 161.9800 23.1400
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 90.000000 7050.1200 78.3347
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 10.000000 785.8800 78.5880
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 14.000000 1109.8000 79.2714
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 38 72.000000 4285.5100 59.5210
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 248 465.500000 35767.6400 76.8370
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 19 38.500000 2944.3100 76.4756
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 72.000000 5615.2800 77.9900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 93.500000 7266.9000 77.7209
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 192 354.500000 20207.3600 57.0024
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 674.8400 56.2367
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 93.500000 7188.9100 76.8867
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 35.9800 35.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 20 21.000000 1200.2100 57.1529
OCTH-97166-OT EVAL MODERATE COMPLEXITY 20 20.000000 1135.4000 56.7700
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 20 22.000000 1211.4200 55.0645
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 43 48.000000 2702.1800 56.2954
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 335.2600 55.8767
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 22 243.000000 14080.9800 57.9464
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 432 1730.500000 115574.7700 66.7869
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.000000 30000.0000 5000.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 955 23922.50000 1263904.0000 52.8333
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 415 5189.000000 274498.0000 52.9000
OCCT-97530-OT SESSION BY LICENSED OT 231 3294.000000 258917.1900 78.6027
OCCT-97530GO-OT SESSION BY LICENSED OT 10 31.000000 2492.8400 80.4142
OCCT-97530GT-OT SESSION BY LICENSED OT 6 21.500000 1678.1800 78.0549
OCCT-97530HM-OT SESSION BY OT ASST 57 569.500000 35401.1100 62.1617
PHY-97110-PT SESSION BY LICENSED PT 276 3652.000000 287099.3700 78.6143
PHY-97110GT-PT SESSION BY LICENSED PT 6 4.000000 311.2400 77.8100
PHY-97110HM-PT SESSION BY PT ASST 35 493.500000 31477.5600 63.7843
PHY-97110HMGT-PT SESSION BY PT ASST 2 2.000000 130.2400 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 1 1.000000 229.6100 229.6100
SENS-V5264-EARMOLD 1 1.000000 18.1300 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 301 4255.500000 332997.3800 78.2511
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 22 87.000000 6852.5400 78.7648
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 96.000000 6202.6800 64.6113
Subtotal (Total Children Is Unduplicated) 1501 41626.50000 2532235.0700 60.8323
-----------------------------------------------------------------------------------------------------------------------
Total 54077.750000 3046465.6400 56.3349
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2104
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 215 184.000000 6977.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 14175 11597.000000 474177.2100 0.0000
P 34 52.250000 3359.8600 428.0000
D 4 3.000000 189.4100 0.0000
S 36 33.500000 1847.5300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
49246 42183.000000 2558983.8300 0.0000
Other 33 25.000000 930.0000 0.0000
---------------------------------------------------------
Total 63743 54077.750000 3046465.6400 428.0000