CMS/EIP Fiscal Report Center: 54
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-92555-SPEECH AUD THRESHOLD (DETECTION) 5 7.000000 113.0500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 12.000000 95.0400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 10.000000 318.1000 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 30.3800 15.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 461.6800 57.7100
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 551.5600 58.0589
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 724.4600 76.2589
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.500000 1552.7700 56.4644
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 36.500000 2067.7400 56.6504
Subtotal (Total Children Is Unduplicated) 55 132.000000 6586.1200 49.8948
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 1069.2500 356.4167
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 107 1047.250000 54984.5000 52.5037
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 63 175.750000 9233.5000 52.5377
PHY-97110-PT SESSION BY LICENSED PT 14 80.000000 6262.2400 78.2780
PHY-97110GT-PT SESSION BY LICENSED PT 6 8.000000 631.8400 78.9800
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
SENS-V5264-EARMOLD 2 6.000000 108.7800 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 345.500000 27179.4400 78.6670
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 20.000000 1551.5200 77.5760
TRAV-TRAVS-Travel by mile 1 10.000000 4.4500 0.4450
Subtotal (Total Children Is Unduplicated) 154 1696.500000 102006.2600 60.1275
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Total 1828.500000 108592.3800 59.3888
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Number of Children (Unduplicated) With at Least One Service 181
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Center 54
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1705 1680.610000 98530.1500 98530.1500
194 147.890000 10062.2300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1899 1828.500000 108592.3800 98530.1500