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:TPIN
Eligibility Filter:Program Patients
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 3 3.000000 64.3800 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 48.4500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 23.7600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 69.4200 23.1400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.500000 850.2900 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.500000 364.4100 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.000000 359.5200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.500000 1348.2000 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 12 12.000000 697.3200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 161.2900 53.7633
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 348.6600 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 2.000000 58.1100 29.0550
SPCH-92521-EVAL OF SPEECH FLUENCY 7 7.000000 406.7700 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 63.000000 3660.9300 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 56 179.000000 10692.4100 59.7341
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 5.000000 10977.5400 2195.5080
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 27.000000 1458.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 100 572.000000 44364.9000 77.5610
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 14 75.000000 4710.9900 62.8132
PHY-97110-PT SESSION BY LICENSED PT 100 553.000000 42191.0100 76.2948
PHY-97110HM-PT SESSION BY PT ASST 6 33.500000 2181.5200 65.1200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 149 798.000000 63796.9700 79.9461
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 17.000000 1382.4400 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 25.500000 1100.5400 43.1584
Subtotal (Total Children Is Unduplicated) 221 2110.000000 172362.8100 81.6885
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Total 2289.000000 183055.2200 79.9717
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Number of Children (Unduplicated) With at Least One Service 244
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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 2261 1466.500000 113468.0400 113468.0400
D 0 0.000000 0.0000 0.0000
S 2 1.750000 126.1100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1278 820.750000 69461.0700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3541 2289.000000 183055.2200 113468.0400