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: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 845 432.500000 16089.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6654 35582.50000 1324136.0000 37.2131
Subtotal (Total Children Is Unduplicated) 6687 36016.00000 1340225.0000 37.2119
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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 409 395.500000 20062.5000 50.7269
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 42.500000 3452.2400 81.2292
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 9.000000 674.7600 74.9733
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-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 722.8400 80.3156
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 433.4300 78.8055
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 74 119.500000 7049.9400 58.9953
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 22.500000 1323.8900 58.8396
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 37 67.500000 5466.1500 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 239 404.500000 31994.2500 79.0958
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 140 248.500000 18447.7100 74.2363
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 89 135.500000 10739.5700 79.2588
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 87 137.500000 10919.4700 79.4143
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 126 220.500000 17610.9100 79.8681
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 84 145.000000 11538.4600 79.5756
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1039 1754.500000 103160.2100 58.7975
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 405 705.500000 41387.8900 58.6646
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 867 1517.500000 121042.4400 79.7644
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 544 986.500000 78245.0100 79.3158
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) 2984 7283.000000 505355.3600 69.3884
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 540 670.000000 33464.0000 49.9463
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 501 680.750000 34125.0000 50.1285
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 186 181.250000 4632.7500 25.5600
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 315 857.250000 42877.0000 50.0169
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 74 166.000000 8300.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 180 601.500000 30075.0000 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 220 595.750000 26584.4600 44.6235
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 197 597.750000 29887.5000 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 1303 18208.75000 965076.0000 53.0007
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 295 1640.000000 86388.0000 52.6756
EPIC-99601-Early Steps Professional Development Fee 599 8518.000000 127770.0000 15.0000
INTR-T1013-INTERPRETER 506 1314.500000 67026.2000 50.9899
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2848 49461.00000 593532.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 80 955.250000 76054.2900 79.6172
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
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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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
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 231 2886.000000 225315.5500 78.0719
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 1002 169671.0000 75595.6700 0.4455
Subtotal (Total Children Is Unduplicated) 3720 262279.0000 2755993.6100 10.5079
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Total 305578.000000 4601573.9700 15.0586
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Number of Children (Unduplicated) With at Least One Service 6763
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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 85769 206601.000000 2170595.8600 2170392.6800
D 2031 4380.250000 73531.1300 0.0000
S 2610 2548.500000 132812.8300 0.0000
H 30285 24767.750000 1118842.0400 945128.5600
T 15302 48793.250000 358283.0900 355472.2500
25517 18382.750000 743621.6200 119.1000
Other 199 103.000000 3831.6000 0.0000
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Total 161717 305578.000000 4601573.9700 3471112.5900