CMS/EIP Fiscal Report Center: 10
Services beginning 04/01/2025 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 749 1927.000000 71407.4000 37.0563
Subtotal (Total Children Is Unduplicated) 749 1927.000000 71407.4000 37.0563
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 21.4600 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 24.000000 1943.5200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 13 24.500000 1468.0400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 39.000000 3158.2200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.500000 526.3700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.000000 728.8200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 35.500000 2127.1600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 9.500000 769.3100 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 11 11.000000 639.2100 58.1100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 9 88.000000 5113.6800 58.1100
Subtotal (Total Children Is Unduplicated) 71 269.000000 17699.9000 65.7989
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.000000 30000.0000 5000.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 442 4642.500000 250695.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 96 533.000000 28782.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 89 557.250000 45315.5700 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 4 14.500000 1179.1400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 18 93.000000 6056.1600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 101 511.000000 41538.5400 81.2887
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 20 150.500000 9800.5600 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 2 2.000000 130.2400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 118 707.000000 57023.4400 80.6555
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 13.750000 1118.1500 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 68.000000 4428.1600 65.1200
Subtotal (Total Children Is Unduplicated) 641 7305.500000 476636.2000 65.2435
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Total 9501.500000 565743.5000 59.5425
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Number of Children (Unduplicated) With at Least One Service 884
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Center 10
Flag Claims Units Chgs Paid
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R 40 39.500000 1469.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 2457 1995.000000 79415.5200 0.0000
P 0 0.000000 0.0000 0.0000
D 1 1.000000 65.1200 0.0000
S 27 27.000000 1458.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8349 7414.000000 482405.4600 0.0000
Other 33 25.000000 930.0000 0.0000
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Total 10907 9501.500000 565743.5000 0.0000