CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 117.3400 14.6675
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 22.0700 22.0700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 79.7700 7.9770
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.000000 230.7600 28.8450
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 41.2300 13.7433
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 2.000000 90.6400 45.3200
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.000000 599.7500 74.9688
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 49.500000 2747.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 80 148.500000 8241.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1500.0000 75.0000
Subtotal (Total Children Is Unduplicated) 151 314.500000 17418.2900 55.3841
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 20.000000 5285.4300 264.2715
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 108 836.250000 41812.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 102 447.750000 22387.5000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 6 45.000000 3237.1600 71.9369
PHY-97110GT-PT SESSION BY LICENSED PT 2 4.000000 287.8400 71.9600
SENS-V5264-EARMOLD 4 9.000000 163.1700 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 174.000000 12520.0000 71.9540
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 5.000000 359.8000 71.9600
Subtotal (Total Children Is Unduplicated) 174 1541.000000 86053.4000 55.8426
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Total 1855.500000 103471.6900 55.7649
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Number of Children (Unduplicated) With at Least One Service 264
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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 1312 1383.480000 78010.8600 77882.1300
431 472.020000 25460.8300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1743 1855.500000 103471.6900 77882.1300