CMS/EIP Fiscal Report Center: 10
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 3186 9059.000000 336920.4000 37.1918
Subtotal (Total Children Is Unduplicated) 3186 9059.000000 336920.4000 37.1918
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 3 3.000000 64.3800 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 48.4500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 39.6000 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 95.4300 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 4 4.000000 92.5600 23.1400
EXIT-EXIT-COS Exit 33 36.000000 1800.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 47 91.000000 7247.7100 79.6452
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 13.500000 1052.7400 77.9807
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 13.500000 1093.2300 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 32 62.500000 3745.0000 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 583 1138.000000 92114.7500 80.9444
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 23.000000 1862.5400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 123 220.000000 17896.5800 81.3481
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 103 197.000000 15912.5700 80.7745
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 481 928.000000 55605.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 299.6000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 123 224.000000 18260.9900 81.5223
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 581.1000 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 639.2100 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 17 17.000000 987.8700 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 35 37.000000 2150.0700 58.1100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 39 227.000000 13097.9600 57.7003
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 845 3294.000000 236258.5800 71.7239
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 4355.6600 1088.9150
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 31.500000 1575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 182 157.000000 7875.0000 50.1592
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 9.250000 231.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 42 57.000000 2850.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 164 276.000000 13800.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 25.000000 1250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 24 45.000000 2250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 14 17.000000 850.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 24.500000 1225.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 156 261.000000 13050.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1178 8749.250000 472459.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 347 1377.000000 74316.0000 53.9695
EPIC-99601-Early Steps Professional Development Fee 483 3750.000000 56250.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1016 9038.000000 108478.4700 12.0025
OCCT-97530-OT SESSION BY LICENSED OT 278 1352.500000 108675.8900 80.3519
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 4.000000 325.2800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 39 164.750000 10568.5200 64.1488
PHY-97110-PT SESSION BY LICENSED PT 371 1557.500000 124875.0500 80.1766
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.500000 365.9400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 27 153.000000 9963.3600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 419 2149.750000 172507.9900 80.2456
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 66.000000 5367.1200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 38.000000 2381.4000 62.6684
Subtotal (Total Children Is Unduplicated) 1919 29316.50000 1196127.7500 40.8005
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Total 41669.500000 1769306.7300 42.4605
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Number of Children (Unduplicated) With at Least One Service 3614
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Center 10
Flag Claims Units Chgs Paid
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R 294 298.500000 11225.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 5955 6175.500000 288735.3000 0.0000
P 21415 20013.500000 616346.5900 616343.1600
D 5 3.750000 175.2200 0.0000
S 15 11.500000 598.7400 149.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
16696 14784.000000 837986.7400 0.0000
Other 490 382.750000 14238.3000 0.0000
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Total 44870 41669.500000 1769306.7300 616492.1600