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
Agency Filter:EXT
Payclass Filters:GR
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-92552-PURE TONE AUDIOMETRY -AIR ONLY 12 13.000000 278.9800 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 13.000000 209.9500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 13.000000 102.9600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 13.000000 413.5300 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 12 13.000000 300.8200 23.1400
EXIT-EXIT-COS Exit 138 143.750000 7151.0000 49.7461
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 219.0400 54.7600
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 303.4700 50.5783
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 17 18.000000 979.5300 54.4183
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 225.7400 56.4350
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 127.000000 7251.9300 57.1018
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 186 374.750000 17843.7200 47.6150
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 72.000000 19641.6300 272.8004
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 130 129.750000 6487.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 501 587.750000 29387.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 48 39.000000 975.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 167 284.000000 14200.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 420 1456.000000 72800.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 113.000000 5650.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 55 189.750000 9512.5000 50.1318
CONOP-CONOP-CONSULT, OT, PHONE 2 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 36.000000 1800.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 83 187.250000 9362.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 118.250000 5912.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 341 1247.500000 62375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 7 27.000000 1350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 600 13827.00000 727214.0000 52.5938
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 275 2754.500000 144134.0000 52.3267
EPIC-99601-Early Steps Professional Development Fee 729 16632.00000 249182.4200 14.9821
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1315 41343.00000 496129.4700 12.0003
OCCT-97530-OT SESSION BY LICENSED OT 83 859.250000 67015.5700 77.9931
OCCT-97530GO-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 14 117.000000 7220.1300 61.7105
PHY-97110-PT SESSION BY LICENSED PT 77 947.500000 73430.0200 77.4987
PHY-97110GT-PT SESSION BY LICENSED PT 2 5.000000 364.4800 72.8960
PHY-97110HM-PT SESSION BY PT ASST 8 66.000000 4105.1400 62.1991
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 116 1438.000000 110440.2400 76.8013
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 57.250000 4369.3500 76.3205
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 41.000000 2669.9200 65.1200
Subtotal (Total Children Is Unduplicated) 2017 82585.75000 2126172.8300 25.7450
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Total 82960.500000 2144016.5500 25.8438
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Number of Children (Unduplicated) With at Least One Service 2019
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Center 10
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 84731 82894.000000 2142683.6300 2142683.6300
D 11 11.000000 371.9200 0.0000
S 45 44.750000 695.5000 186.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11 10.750000 265.5000 105.0000
Other 0 0.000000 0.0000 0.0000
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Total 84798 82960.500000 2144016.5500 2142975.1300