CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2476 6223.750000 231291.9000 37.1628
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 115 90.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2593 11220.00000 416965.4500 37.1627
Subtotal (Total Children Is Unduplicated) 2828 17534.50000 648257.3500 36.9704
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 4.000000 194.0000 48.5000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 5 5.000000 79.2000 15.8400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 29.3600 14.6800
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 8.8100 8.8100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 15.000000 132.1500 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 19 22.000000 627.2400 28.5109
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 82.8600 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 2 2.000000 150.2600 75.1300
EXIT-EXIT-COS Exit 8 10.000000 500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 33.500000 2512.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 28 49.500000 3712.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 15 27.500000 2062.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 22.000000 1650.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 45 86.500000 4800.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 92 171.500000 13011.0000 75.8659
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 288 509.500000 38512.5000 75.5888
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 89.500000 7050.0000 78.7709
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 255 474.000000 35512.5000 74.9209
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 64.500000 4837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 156 274.000000 20925.0000 76.3686
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 113.500000 6299.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 557 1026.500000 57021.0000 55.5490
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 60.000000 4500.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 105.000000 7873.5000 74.9857
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.8200 51.4100
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 11.580000 595.5100 51.4257
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 8 80.420000 4134.2000 51.4076
Subtotal (Total Children Is Unduplicated) 903 3295.500000 218740.4400 66.3755
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 12 20.000000 4239.9100 211.9955
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 43.000000 2150.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 68 69.250000 3496.9600 50.4976
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 33.500000 1675.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 365 382.750000 19175.0000 50.0980
CONIP-CONIP-CONSULT, ITDS PHONE 8 7.750000 193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 126 231.500000 11537.5000 49.8380
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 267 347.000000 17350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 94 228.000000 11400.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 461 344.750000 17250.0000 50.0363
CONPP-CONPP-CONSULT, PT, PHONE 50 25.000000 631.2500 25.2500
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 166 260.000000 13000.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 474 484.250000 24200.0000 49.9742
CONSP-CONSP-CONSULT, SLP, PHONE 50 40.750000 1043.7500 25.6135
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 817 5352.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 745 7832.750000 391337.5000 49.9617
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 480 1746.500000 87299.7000 49.9855
EPIC-99601-Early Steps Professional Development Fee 1039 11729.00000 175932.0000 14.9997
INTR-T1013-INTERPRETER 8 11.000000 449.7100 40.8827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 476 3261.000000 39132.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 130 1308.500000 95634.3800 73.0870
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 66 199.000000 15376.5200 77.2689
OCCT-97530TL-OT SESSION BY LICENSED OT 97 686.500000 49400.5400 71.9600
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 15.500000 1115.3800 71.9600
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 4 17.000000 1223.3200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 49 160.000000 11477.6200 71.7351
PHY-97110-PT SESSION BY LICENSED PT 57 698.600000 70485.8100 100.8958
CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110GT-PT SESSION BY LICENSED PT 23 28.250000 2536.9900 89.8050
PHY-97110TL-PT SESSION BY LICENSED PT 83 1081.040000 78331.4200 72.4593
PHY-97110TLGT-PT SESSION BY LICENSED PT 27 40.750000 2932.3700 71.9600
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 359.4200 359.4200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 145 1197.170000 88402.9000 73.8432
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 142.270000 11576.7200 81.3715
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 146 1205.130000 86719.9500 71.9590
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 64 195.230000 14048.3700 71.9580
TRAV-TRAVS-Travel by mile 648 102352.0000 45531.2200 0.4448
Subtotal (Total Children Is Unduplicated) 1398 141796.9400 1397554.2100 9.8560
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Total 162626.940000 2264552.0000 13.9248
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Number of Children (Unduplicated) With at Least One Service 2866
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Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 8.250000 464.8200 0.0000
P 15218 14370.140000 764398.2700 743340.9300
D 3054 2761.720000 167266.2300 31.5700
S 16 10.950000 663.5600 0.0000
H 26 17.750000 729.8200 0.0000
T 17087 112417.058807 303709.5209 269966.1100
43772 32973.441193 1022838.8191 0.0000
Other 78 67.630000 4480.9600 50.0000
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Total 79260 162626.940000 2264552.0000 1013388.6100