CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 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 1685 2472.500000 91930.5000 37.1812
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 102 105.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1594 3295.750000 122601.9000 37.2000
Subtotal (Total Children Is Unduplicated) 1906 5874.000000 214532.4000 36.5224
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 61.7100 61.7100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 23.7600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 46.2800 23.1400
EXIT-EXIT-COS Exit 83 92.250000 4800.0000 52.0325
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 719.0400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 106.000000 8483.8800 80.0366
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 44 88.000000 7026.2400 79.8436
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 138.000000 11169.6400 80.9394
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 35 70.000000 5668.6000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 108.000000 8745.8400 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 26 52.000000 4210.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 122 244.000000 14620.4800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 100 200.000000 11984.0000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 108.000000 8745.8400 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.000000 3563.1200 80.9800
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 7 7.000000 406.7700 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 9 9.000000 522.9900 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 4 4.000000 215.9200 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 290.5500 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 813.5400 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 10 47.000000 2731.1700 58.1100
Subtotal (Total Children Is Unduplicated) 473 1394.250000 97618.1200 70.0148
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 3994.7300 1997.3650
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 46.250000 2312.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 136 172.500000 8625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 10.500000 262.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 187 259.250000 12962.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 215 371.750000 18587.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 66 73.750000 3687.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 100 141.750000 7087.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 41.750000 2087.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 42 55.750000 2787.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 100 119.750000 5987.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 105 135.000000 6750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 99 154.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 550 2962.000000 159948.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 85 192.500000 10395.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 614 3415.000000 51225.0000 15.0000
INTR-T1013-INTERPRETER 1 3.250000 221.1000 68.0308
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 980 6363.000000 76469.0000 12.0178
OCCT-97530-OT SESSION BY LICENSED OT 53 299.250000 23767.4100 79.4233
OCCT-97530GO-OT SESSION BY LICENSED OT 1 2.000000 82.8400 41.4200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 11.000000 894.5200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 7 28.000000 1823.3600 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 57 287.000000 22512.7400 78.4416
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 89 462.750000 36129.4000 78.0754
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.750000 630.2300 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 9 31.000000 2018.7200 65.1200
CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 2
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 6 44.000000 2865.2800 65.1200
TRAV-TRAVS-Travel by mile 48 3128.000000 1391.3800 0.4448
Subtotal (Total Children Is Unduplicated) 1447 18839.00000 466457.0700 24.7602
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Total 26107.250000 778607.5900 29.8234
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Number of Children (Unduplicated) With at Least One Service 2264
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Center 07
Flag Claims Units Chgs Paid
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R 45 37.750000 1932.9800 0.0000
U 0 0.000000 0.0000 0.0000
B 885 746.500000 32544.5200 0.0000
P 17866 20660.799400 564552.2354 563877.0300
D 30 23.000000 1205.8400 0.0000
S 0 0.000000 0.0000 0.0000
H 12 21.000000 1701.6000 0.0000
T 0 0.000000 0.0000 0.0000
7629 4533.700600 173072.4346 58.1100
Other 187 84.500000 3597.9800 0.0000
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Total 26654 26107.250000 778607.5900 563935.1400