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
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-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
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 200.8800 57.3943
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
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) 33 63.500000 3280.8000 51.6661
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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 825.384916 52498.5000 63.6049
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Number of Children (Unduplicated) With at Least One Service 67
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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 5 5.000000 107.7500 0.0000
T 397 352.793003 24984.6300 24984.6300
453 422.685509 24265.4300 960.0200
Other 0 0.000000 0.0000 0.0000
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Total 910 825.384916 52498.5000 27527.7700