CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 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-92552-PURE TONE AUDIOMETRY -AIR ONLY 18 20.000000 386.2800 19.3140
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 18 20.000000 290.7000 14.5350
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 19 19.000000 161.2100 8.4847
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 18 20.000000 572.5800 28.6290
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 20 21.000000 478.8900 22.8043
AUDE-92650-AEP SCR AUDITORY POTENTIAL 1 1.000000 54.9000 54.9000
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 2.000000 141.4400 70.7200
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 231.6200 115.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.500000 931.2700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 14.000000 838.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 98 218.000000 17653.6400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.500000 202.4500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 46.500000 3765.5700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 31.000000 2510.3800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 66 133.000000 7969.3600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 54.500000 4413.4100 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 15 15.000000 871.6500 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 5 7.000000 290.5500 41.5071
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 464.8800 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 13 15.000000 823.1900 54.8793
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 290.5500 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 27 169.000000 9820.5900 58.1100
Subtotal (Total Children Is Unduplicated) 193 839.000000 53429.3800 63.6822
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 12.250000 661.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 324.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 133 651.250000 49187.2100 75.5274
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 23 132.500000 7294.0300 55.0493
PHY-97110-PT SESSION BY LICENSED PT 161 740.250000 57798.1900 78.0793
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 13 45.500000 2897.8400 63.6888
PHY-97110HMGT-PT SESSION BY PT ASST 2 2.000000 130.2400 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 459.2200 229.6100
SENS-V5264-EARMOLD 2 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 216 1058.000000 83358.1900 78.7885
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 325.2800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 38.250000 2425.7200 63.4175
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 3.000000 47.2800 15.7600
Subtotal (Total Children Is Unduplicated) 362 2701.500000 205184.5200 75.9521
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Total 3540.500000 258613.9000 73.0445
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Number of Children (Unduplicated) With at Least One Service 483
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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 3023 2041.250000 147545.9800 147545.9800
D 0 0.000000 0.0000 0.0000
S 5 5.000000 341.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1894 1494.250000 110726.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4922 3540.500000 258613.9000 147545.9800