CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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 770 392.500000 14601.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 5946 31790.50000 1183101.5000 37.2156
Subtotal (Total Children Is Unduplicated) 5977 32184.00000 1197702.5000 37.2142
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 40 51.000000 2473.5000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 15.8400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 63.6200 31.8100
EXIT-EXIT-COS Exit 406 392.500000 19912.5000 50.7325
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 39.000000 3128.3200 80.2133
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.000000 701.9100 77.9900
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 62 101.000000 5959.1000 59.0010
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 15.500000 904.4500 58.3516
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 35 64.500000 5223.2100 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 187 332.000000 26200.9400 78.9185
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 99 181.500000 13433.8200 74.0155
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 63 100.500000 7956.1000 79.1652
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 63 105.000000 8317.5200 79.2145
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 80 150.500000 11993.1400 79.6886
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 59 104.000000 8275.4100 79.5713
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 771 1354.500000 79577.0000 58.7501
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 312 560.000000 32799.9200 58.5713
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 669 1201.500000 95790.6300 79.7259
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 441 816.500000 64799.7100 79.3628
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 13 14.000000 813.5400 58.1100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 451.4800 56.4350
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
SPCH-92521-EVAL OF SPEECH FLUENCY 7 21.000000 1206.9100 57.4719
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 16.000000 902.9600 56.4350
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 4.000000 219.1900 54.7975
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 19 142.000000 9065.6900 63.8429
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 10 58.000000 3296.6800 56.8393
Subtotal (Total Children Is Unduplicated) 2370 5878.500000 405638.8900 69.0038
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 539 669.000000 33414.0000 49.9462
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 498 677.250000 33950.0000 50.1292
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 186 181.250000 4632.7500 25.5600
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 314 854.250000 42727.0000 50.0170
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 356 1405.000000 60705.0000 43.2064
CONIP-CONIP-CONSULT, ITDS PHONE 47 73.500000 1887.5000 25.6803
CONOF-CONOF-CONSULT, OT, FACE TO FACE 73 165.000000 8250.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 179 599.500000 29975.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 29 42.750000 1068.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 93 145.250000 7262.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 166 485.500000 24275.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 28 54.000000 1375.0000 25.4630
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 219 592.750000 26434.4600 44.5963
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 196 594.750000 29737.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 48 65.500000 1762.5000 26.9084
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 54.0000 54.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 6 8.000000 412.0000 51.5000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1301 18179.75000 963522.0000 52.9997
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 294 1623.000000 85486.0000 52.6716
EPIC-99601-Early Steps Professional Development Fee 596 8500.000000 127500.0000 15.0000
INTR-T1013-INTERPRETER 422 1169.000000 59740.1000 51.1036
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2839 49253.00000 591036.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 79 920.250000 73292.3300 79.6439
OCCT-97530GO-OT SESSION BY LICENSED OT 5 18.000000 1463.7600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 5 6.500000 519.2200 79.8800
OCCT-97530GT-OT SESSION BY LICENSED OT 26 105.000000 8313.9600 79.1806
OCCT-97530TL-OT SESSION BY LICENSED OT 13 91.000000 7035.0800 77.3086
OCCT-97530TLGT-OT SESSION BY LICENSED OT 7 24.000000 1876.8000 78.2000
PHY-97110-PT SESSION BY LICENSED PT 136 2073.750000 160877.8800 77.5782
CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 30 148.500000 11824.8000 79.6283
PHY-97110TL-PT SESSION BY LICENSED PT 18 137.500000 10935.8000 79.5331
PHY-97110TLGT-PT SESSION BY LICENSED PT 7 15.000000 1154.2800 76.9520
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 229 2815.000000 219635.4300 78.0232
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 34 211.000000 16592.2400 78.6362
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 54.000000 3516.4800 65.1200
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 6.000000 390.7200 65.1200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 12 63.500000 4932.1600 77.6718
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 315.9200 78.9800
SPL-92508HA-GROUP SPL SESSION PER CHILD 4 31.000000 458.8800 14.8026
TRAV-TRAVS-Travel by mile 931 167739.0000 74734.2400 0.4455
Subtotal (Total Children Is Unduplicated) 3571 259807.0000 2733357.0000 10.5207
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Total 297869.500000 4336698.3900 14.5591
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Number of Children (Unduplicated) With at Least One Service 6046
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 1.500000 55.8000 0.0000
P 85056 204316.250000 2134017.6600 2133814.4800
D 2007 4162.750000 72323.0200 0.0000
S 2368 2262.750000 116419.4100 0.0000
H 27166 21924.000000 984168.0200 835263.7600
T 15242 48526.500000 354117.3300 351427.9600
23348 16602.500000 672872.2500 119.1000
Other 152 73.250000 2724.9000 0.0000
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Total 155343 297869.500000 4336698.3900 3320625.3000