CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.1900 15.1900
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 2 2.000000 63.6200 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 46.2800 23.1400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 8.500000 679.3600 79.9247
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 80.9800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 13.500000 1063.3300 78.7652
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 566.8600 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 16 28.500000 1678.9900 58.9119
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.000000 359.5200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 27.500000 2107.3500 76.6309
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 35.000000 2654.9000 75.8543
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 842.9400 76.6309
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.500000 985.3400 78.8272
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 43 74.000000 4202.0300 56.7842
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 17.500000 984.5100 56.2577
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 12 19.000000 1070.5900 56.3468
OCTH-97167-OT EVAL HIGH COMPLEXITY 7 7.000000 386.6700 55.2386
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 7.000000 400.0700 57.1529
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 225.7400 56.4350
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 502.8900 55.8767
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 100 312.000000 20092.9700 64.4005
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 296.000000 15500.0000 52.3649
OCCT-97530-OT SESSION BY LICENSED OT 18 240.384910 18628.7600 77.4955
OCCT-97530GO-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 4 113.000006 7117.9200 62.9904
PHY-97110HM-PT SESSION BY PT ASST 3 35.500000 2122.7600 59.7961
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 46.000000 3436.5200 74.7070
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 23.500000 1873.5800 79.7268
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 3.500000 212.8800 60.8229
Subtotal (Total Children Is Unduplicated) 48 761.884916 49217.7000 64.5999
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Total 1073.884916 69310.6700 64.5420
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Number of Children (Unduplicated) With at Least One Service 134
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Center 57
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 35 24.906404 1780.3400 1583.1200
D 20 20.000000 1360.3500 0.0000
S 0 0.000000 0.0000 0.0000
H 134 215.500000 14398.9500 14291.2000
T 397 352.793003 24984.6300 24984.6300
475 460.685509 26786.4000 960.0200
Other 0 0.000000 0.0000 0.0000
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Total 1061 1073.884916 69310.6700 41818.9700