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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 4.000000 148.8000 37.2000
Subtotal (Total Children Is Unduplicated) 2 4.000000 148.8000 37.2000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 0.000000 0.0000 0.0000
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 4 7.000000 350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 29.000000 2175.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 79 127.000000 9525.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 31.500000 2362.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 101 182.000000 13650.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 23.000000 1276.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 188 339.500000 18836.7500 55.4838
Subtotal (Total Children Is Unduplicated) 409 882.000000 55128.2100 62.5036
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 11.000000 3592.2700 326.5700
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 9.500000 475.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 8.750000 437.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 61 93.000000 4650.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 6 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 39.250000 1962.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 3 4.250000 212.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 3.000000 75.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 447 5466.750000 273037.5000 49.9451
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 265 1200.000000 60000.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 423 5012.000000 75180.0000 15.0000
INTR-T1013-INTERPRETER 8 11.000000 449.7100 40.8827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 267 2148.000000 25776.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 100 1056.000000 75967.8000 71.9392
OCCT-97530GT-OT SESSION BY LICENSED OT 50 123.000000 8851.0800 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 25 123.000000 8851.0800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 5 8.000000 575.6800 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 50 357.000000 25689.7200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 31.000000 2230.7600 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 23 95.000000 6836.2000 71.9600
TRAV-TRAVS-Travel by mile 648 102352.0000 45531.2200 0.4448
Subtotal (Total Children Is Unduplicated) 735 118175.0000 621771.3200 5.2614
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Total 119061.000000 677048.3300 5.6866
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Number of Children (Unduplicated) With at Least One Service 899
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Center 53
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 1 1.000000 71.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 17087 112417.058807 303709.5209 269966.1100
6388 6642.941193 373266.8491 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 23476 119061.000000 677048.3300 269966.1100