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
Agency Filter:EXT
Payclass Filters:GR
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 1 0.250000 9.3000 37.2000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.3000 37.2000
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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) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 9.000000 78.4000 8.7111
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 176.4100 29.4017
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 42.8100 14.2700
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 67.3200 22.4400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 21.000000 1254.1300 59.7205
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 68.000000 3774.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1554.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 22.000000 1496.2500 68.0114
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 393.7500 65.6250
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 103.9500 34.6500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 3.000000 154.2300 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 11 11.000000 565.5100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 389.4400 43.2711
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 27.000000 1163.0700 43.0767
Subtotal (Total Children Is Unduplicated) 106 257.000000 13529.2000 52.6428
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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 130 184.000000 9200.0000 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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 584 4936.000000 246476.2400 49.9344
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 113 308.750000 15445.5000 50.0259
EPIC-99601-Early Steps Professional Development Fee 730 6596.000000 98940.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1159 10999.00000 131976.4400 11.9989
OCCT-97530-OT SESSION BY LICENSED OT 34 201.250000 12942.4800 64.3105
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 3 19.000000 1367.2400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 37 239.250000 16816.7300 70.2894
PHY-97110GT-PT SESSION BY LICENSED PT 3 11.750000 696.7300 59.2962
PHY-97110HM-PT SESSION BY PT ASST 1 8.000000 460.4800 57.5600
SENS-V5264-EARMOLD 1 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 357.500000 21523.6700 60.2061
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 52.000000 2419.2000 46.5231
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 4 57.750000 3326.4000 57.6000
TRAV-TRAVS-Travel by mile 62 3570.000000 1588.2400 0.4449
Subtotal (Total Children Is Unduplicated) 1660 29670.75000 672204.2900 22.6555
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Total 29928.000000 685742.7900 22.9131
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Number of Children (Unduplicated) With at Least One Service 1670
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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 0 0.000000 0.0000 0.0000
P 26622 29939.750000 686221.2200 686221.2200
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 0 0.000000 0.0000 0.0000
3 2.250000 131.2600 0.0000
Other 21 -15.000000 -681.6500 -681.6500
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Total 26647 29928.000000 685742.7900 685539.5700