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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2771 6773.750000 251751.9000 37.1658
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 132 101.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2911 12852.75000 477657.2500 37.1638
Subtotal (Total Children Is Unduplicated) 3157 19728.00000 729409.1500 36.9733
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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 20 39.000000 2925.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 31 55.000000 4125.0000 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 20 36.500000 2737.5000 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 14 26.000000 1950.0000 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 57 110.500000 6132.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 113 208.000000 15748.5000 75.7139
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 396 685.000000 51637.5000 75.3832
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 62 113.000000 8812.5000 77.9867
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 342 617.000000 46425.0000 75.2431
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 80.000000 6000.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 219 370.000000 28066.5000 75.8554
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 77 143.500000 8003.2500 55.7718
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 758 1357.500000 75391.5000 55.5370
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 73.500000 5512.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 143.500000 10761.0000 74.9895
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) 1203 4246.500000 282688.4400 66.5697
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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 366 383.000000 19187.5000 50.0979
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 462 345.000000 17262.5000 50.0362
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 475 484.500000 24212.5000 49.9742
CONSP-CONSP-CONSULT, SLP, PHONE 50 40.750000 1043.7500 25.6135
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 845 5389.750000 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 1066 11797.00000 176952.0000 14.9997
INTR-T1013-INTERPRETER 8 11.000000 449.7100 40.8827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 502 3289.000000 39468.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 131 1334.500000 97505.3400 73.0651
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:Program Patients
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 658 103178.0000 45898.7200 0.4448
Subtotal (Total Children Is Unduplicated) 1437 142783.1900 1401186.1700 9.8134
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Total 166757.690000 2413283.7600 14.4718
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Number of Children (Unduplicated) With at Least One Service 3205
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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 12 12.250000 613.6200 0.0000
P 16540 15840.510000 833183.0500 811640.8600
D 3183 2926.320000 177444.1800 31.5700
S 18 13.980000 890.6300 0.0000
H 26 17.750000 729.8200 0.0000
T 17196 113337.058807 308051.2709 274014.1500
45815 34542.191193 1087890.2291 0.0000
Other 78 67.630000 4480.9600 50.0000
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Total 82868 166757.690000 2413283.7600 1085736.5800