CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 1717 2343.250000 86966.3000 37.1135
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 99 197.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1658 3540.500000 131587.9500 37.1665
Subtotal (Total Children Is Unduplicated) 1981 6081.500000 218554.2500 35.9376
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Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.8400 15.8400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 30.8300 15.4150
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 2.000000 48.5600 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 16.000000 139.1800 8.6988
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 12.000000 352.8200 29.4017
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 56.6200 14.1550
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 67.3200 22.4400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0043 75.0011
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 666.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 131.000000 9504.1386 72.5507
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 38 76.000000 5700.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 45 90.000000 6750.0105 75.0001
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 25 50.000000 3637.5000 72.7500
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 59 118.000000 8850.0107 75.0001
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2250.0093 75.0003
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 101 202.000000 11211.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 74 148.000000 8214.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 97.000000 7196.2582 74.1882
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 56.000000 4032.7530 72.0134
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 103.9500 34.6500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 9 9.000000 462.6900 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 3.000000 154.2300 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 14 14.000000 719.7400 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 6 6.000000 315.1600 52.5267
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 30 30.000000 1469.0500 48.9683
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 54.000000 2551.1400 47.2433
Subtotal (Total Children Is Unduplicated) 379 1227.000000 78211.8646 63.7424
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 3483.3300 1741.6650
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 79 75.750000 3787.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 208 242.500000 12125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 22 18.000000 450.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 250 442.000000 22100.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 267 529.500000 26475.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.750000 68.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 131 185.000000 9250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 125 181.750000 9087.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 49 79.750000 3987.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 55 90.500000 4525.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 159 243.750000 12187.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 134 201.250000 10062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 9 11.000000 275.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 76 147.500000 150.0000 1.0169
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 620 5211.000000 260234.2400 49.9394
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 115 314.750000 15745.5000 50.0254
EPIC-99601-Early Steps Professional Development Fee 730 6596.000000 98940.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1159 11172.00000 134348.4400 12.0255
OCCT-97530-OT SESSION BY LICENSED OT 73 490.500000 33756.9100 68.8214
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 25.500000 1834.9800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 67 505.500000 35955.0800 71.1278
PHY-97110GT-PT SESSION BY LICENSED PT 7 23.750000 1560.2500 65.6947
PHY-97110HM-PT SESSION BY PT ASST 1 8.000000 460.4800 57.5600
SENS-V5264-EARMOLD 2 8.000000 145.0400 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 147 1134.500000 77466.1300 68.2822
CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 22.000000 1583.1200 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 57.000000 2707.2000 47.4947
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 4 61.750000 3556.8000 57.6000
TRAV-TRAVS-Travel by mile 62 3570.000000 1588.2400 0.4449
Subtotal (Total Children Is Unduplicated) 1680 31657.25000 788090.9100 24.8945
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Total 38965.750000 1084857.0246 27.8413
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Number of Children (Unduplicated) With at Least One Service 2310
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Center 07
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 24 20.000000 983.6000 0.0000
P 31398 34289.062700 913236.2471 912819.1900
D 116 122.750000 7020.2600 0.0000
S 0 0.000000 0.0000 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
8002 4473.187300 160497.8675 0.0000
Other 144 34.750000 1169.0500 -681.6500
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Total 39697 38965.750000 1084857.0246 912137.5400