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: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-92552-PURE TONE AUDIOMETRY -AIR ONLY 28 34.000000 729.6400 21.4600
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 26.0400 26.0400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 28 34.000000 549.1000 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.2300 23.2300
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 30 37.000000 301.8900 8.1592
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 28 37.000000 1049.7300 28.3711
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 29 35.000000 920.0300 26.2866
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 4.000000 135.9600 33.9900
AUDE-V5090-DISPENSING FEE PER HEARING AID 3 4.000000 463.2400 115.8100
OCTH-97165-OT EVAL LOW COMPLEXITY 31 40.000000 2199.2900 54.9823
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 31 40.000000 1811.2700 45.2818
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 13.3500 13.3500
PSTH-97161-PT EVAL LOW COMPLEXITY 25 34.000000 1850.6300 54.4303
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 6.000000 174.3300 29.0550
SPCH-92521-EVAL OF SPEECH FLUENCY 71 82.000000 4458.7100 54.3745
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 10.000000 482.7900 48.2790
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 31 357.000000 19705.8500 55.1985
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 6.000000 348.6600 58.1100
Subtotal (Total Children Is Unduplicated) 169 766.000000 35411.3700 46.2289
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 20.000000 24611.1200 1230.5560
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 72.000000 3852.0000 53.5000
OCCT-97530-OT SESSION BY LICENSED OT 254 3597.000000 267769.9600 74.4426
OCCT-97530GO-OT SESSION BY LICENSED OT 5 9.000000 731.8800 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 4.500000 333.1800 74.0400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 7.000000 522.4400 74.6343
OCCT-97530HM-OT SESSION BY OT ASST 48 497.750000 28869.3000 57.9996
PHY-97110-PT SESSION BY LICENSED PT 234 3899.000000 288526.1200 74.0000
PHY-97110GT-PT SESSION BY LICENSED PT 2 7.000000 481.7800 68.8257
PHY-97110HM-PT SESSION BY PT ASST 15 188.500000 11757.2500 62.3727
SENS-V5050-IN EAR MONAURAL HEARING AID 3 3.000000 688.8300 229.6100
SENS-V5264-EARMOLD 4 7.000000 126.9100 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 392 5895.000000 448891.0700 76.1478
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 172.250000 13173.5100 76.4790
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 9 63.500000 3015.3000 47.4850
Subtotal (Total Children Is Unduplicated) 557 14442.50000 1093350.6500 75.7037
-----------------------------------------------------------------------------------------------------------------------
Total 15208.500000 1128762.0200 74.2192
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 578
-----------------------------------------------------------------------------------------------------------------------
Center 10
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 15829 10166.750000 751043.3600 751045.7100
D 25 25.000000 929.9600 0.0000
S 16 8.750000 676.6300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8950 5008.000000 376112.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24820 15208.500000 1128762.0200 751045.7100