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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 418 226.750000 8435.1000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1435 6702.250000 250244.4000 37.3374
Subtotal (Total Children Is Unduplicated) 1649 6930.000000 258679.5000 37.3275
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 34 43.000000 2085.5000 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 371 355.250000 18087.5000 50.9148
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 242.9400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 8.500000 509.3200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 173.1300 57.7100
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 808.4300 76.9933
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.000000 852.6000 60.9000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 421.4700 76.6309
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 424.4600 77.1745
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 28 47.500000 2564.9800 53.9996
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.500000 1868.0900 55.7639
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 37.000000 2813.8700 76.0505
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.500000 2029.3600 76.5796
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 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
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
SPCH-92521-EVAL OF SPEECH FLUENCY 2 15.000000 871.6500 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 109.5200 54.7600
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 102.9700 51.4850
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 19.000000 1030.3900 54.2311
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 13.000000 735.3300 56.5638
Subtotal (Total Children Is Unduplicated) 488 677.750000 37883.7600 55.8964
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 476 606.500000 30289.0000 49.9406
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 429 604.500000 30287.5000 50.1034
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 155 154.250000 3956.7500 25.6515
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 261 773.000000 38650.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 286 1254.750000 53237.5000 42.4288
CONIP-CONIP-CONSULT, ITDS PHONE 38 61.500000 1587.5000 25.8130
CONOF-CONOF-CONSULT, OT, FACE TO FACE 60 138.750000 6937.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 152 533.250000 26662.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 25 39.250000 981.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 78 121.250000 6062.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 136 435.500000 21775.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 25 49.250000 1256.2500 25.5076
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 199 555.750000 24584.4600 44.2365
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 167 543.000000 27150.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 40 53.500000 1437.5000 26.8692
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 3.000000 162.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 322 3025.500000 159512.0000 52.7225
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 69 385.250000 20104.5000 52.1856
EPIC-99601-Early Steps Professional Development Fee 403 6573.000000 98595.0000 15.0000
INTR-T1013-INTERPRETER 192 673.250000 33466.1000 49.7083
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1876 38507.00000 462084.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 97.500000 7807.0200 80.0720
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 8 19.000000 1507.6400 79.3495
PHY-97110-PT SESSION BY LICENSED PT 45 383.250000 27647.4200 72.1394
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 3.000000 243.9600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 6 46.000000 3672.8400 79.8443
PHY-97110TL-PT SESSION BY LICENSED PT 2 12.000000 957.1200 79.7600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 59 312.750000 23023.5600 73.6165
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 37.000000 2924.6000 79.0432
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 17.000000 1107.0400 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 1 11.750000 899.3500 76.5404
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 243.9600 81.3200
SPL-92508HA-GROUP SPL SESSION PER CHILD 4 12.000000 166.6400 13.8867
TRAV-TRAVS-Travel by mile 553 121655.0000 54208.4000 0.4456
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 2281 177709.2500 1173823.0400 6.6053
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Total 185317.000000 1470386.3000 7.9344
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Number of Children (Unduplicated) With at Least One Service 2831
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Center 01
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 58019 152796.500000 1016793.6000 1016728.4200
D 927 2232.000000 18750.6200 0.0000
S 15 14.250000 497.1500 0.0000
H 0 0.000000 0.0000 0.0000
T 6471 21985.750000 103890.2100 103783.6600
11834 8288.000000 330436.1200 0.0000
Other 1 0.500000 18.6000 0.0000
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Total 77267 185317.000000 1470386.3000 1120512.0800