CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 3.000000 185.1300 61.7100
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 60.9900 60.9900
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
AUDE-V5090-DISPENSING FEE PER HEARING AID 2 3.000000 347.4300 115.8100
EXIT-EXIT-COS Exit 60 60.000000 3000.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 60.500000 4770.7200 78.8549
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1445.6800 80.3156
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 54.500000 4299.7900 78.8952
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 114.000000 6711.5400 58.8732
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 599.2000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 73 159.000000 12636.3600 79.4740
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 736.4200 77.5179
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 142.2900 47.4300
OCTH-97165-OT EVAL LOW COMPLEXITY 11 11.000000 605.7100 55.0645
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 5.000000 283.8500 56.7700
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 9.000000 446.4300 49.6033
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 216.8000 54.2000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 225.7400 56.4350
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 21.000000 1022.9000 48.7095
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 248 566.500000 38713.8200 68.3386
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 8.000000 917.3900 114.6738
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 84 112.250000 5612.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 106 128.250000 6412.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 125 155.750000 7787.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 124 140.000000 7000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 32 36.500000 1825.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 27 20.750000 1037.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 19.000000 950.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 66 78.000000 3900.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 225 2777.500000 146812.0000 52.8576
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 65 191.500000 10117.0000 52.8303
EPIC-99601-Early Steps Professional Development Fee 571 7930.000000 118979.0000 15.0037
INTR-T1013-INTERPRETER 70 324.750000 16237.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 252 2413.000000 28959.0000 12.0012
OCCT-97530-OT SESSION BY LICENSED OT 70 814.250000 61517.7600 75.5514
OCCT-97530GO-OT SESSION BY LICENSED OT 1 7.500000 609.9000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 23.000000 1673.8000 72.7739
OCCT-97530HM-OT SESSION BY OT ASST 4 8.000000 495.0600 61.8825
PHY-97110-PT SESSION BY LICENSED PT 23 169.750000 13576.2400 79.9778
PHY-97110HM-PT SESSION BY PT ASST 10 65.500000 3025.0000 46.1832
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
SENS-V5264-EARMOLD 2 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 82 683.750000 51264.4600 74.9754
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 10.000000 813.2000 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 81.500000 4898.0400 60.0987
TRAV-TRAVS-Travel by mile 315 24603.00000 10946.2300 0.4449
Subtotal (Total Children Is Unduplicated) 877 40812.00000 506991.5600 12.4226
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Total 41378.500000 545705.3800 13.1881
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Number of Children (Unduplicated) With at Least One Service 901
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Center 02
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 16482 38262.500000 496093.8200 479303.3000
1668 3112.250000 49730.4000 0.0000
Other 4 3.750000 -118.8400 181.1600
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Total 18154 41378.500000 545705.3800 479484.4600