CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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
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 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 15.8400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 63.6200 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 4.000000 118.4400 29.6100
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EXIT-EXIT-COS Exit 120 93.500000 4631.2500 49.5321
Subtotal (Total Children Is Unduplicated) 128 107.500000 5075.3200 47.2123
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 47.3500 47.3500
AUDE-V5160-DISPENSING FEE BINAURAL 2 2.000000 461.2400 230.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 79 88.250000 4150.0000 47.0255
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 65 70.750000 3312.5000 46.8198
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 56 53.500000 1306.2500 24.4159
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 7 11.000000 550.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 6 7.500000 375.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.500000 325.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 6 7.500000 375.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 936 7377.750000 367309.1000 49.7861
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 224 1032.500000 51008.0000 49.4024
EPIC-99601-Early Steps Professional Development Fee 509 4062.000000 60375.0000 14.8634
INTR-T1013-INTERPRETER 37 330.250000 20595.0000 62.3618
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 496 3755.000000 44907.0000 11.9593
OCCT-97530-OT SESSION BY LICENSED OT 11 55.500000 3216.4700 57.9544
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 3.000000 215.8800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 27.000000 1799.0000 66.6296
OCCT-97530HM-OT SESSION BY OT ASST 2 8.500000 259.2000 30.4941
OCCT-97530HMGT-OT SESSION BY OT ASST 4 20.750000 1217.0900 58.6549
PHY-97110-PT SESSION BY LICENSED PT 22 223.500000 14097.5200 63.0762
PHY-97110GT-PT SESSION BY LICENSED PT 5 29.500000 1672.8700 56.7075
PHY-97110HM-PT SESSION BY PT ASST 13 87.250000 4905.9300 56.2284
PHY-97110HMGT-PT SESSION BY PT ASST 8 42.500000 2457.1000 57.8141
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 8 14.000000 271.9500 19.4250
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 315.000000 21133.8800 67.0917
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 28 130.500000 9043.1900 69.2965
Subtotal (Total Children Is Unduplicated) 1161 17781.00000 616539.6600 34.6741
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Total 17888.500000 621614.9800 34.7494
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Number of Children (Unduplicated) With at Least One Service 1167
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Center 06
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 12670 12784.000000 359718.6300 359718.6300
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 0 0.000000 0.0000 0.0000
5144 5104.500000 261896.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17814 17888.500000 621614.9800 359718.6300