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
Payclass Filters:TPIN
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
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 231.6200 115.8100
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 311.9600 77.9900
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 142.2900 47.4300
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 321.8600 53.6433
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 4.000000 225.7400 56.4350
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 7.000000 330.2100 47.1729
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 158.6900 52.8967
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 109.5200 54.7600
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 9.000000 376.5100 41.8344
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 33 47.000000 2673.1200 56.8749
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.000000 733.6500 122.2750
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 14.000000 736.0000 52.5714
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 2 3.000000 45.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 48 572.250000 42333.3600 73.9770
OCCT-97530GO-OT SESSION BY LICENSED OT 1 7.500000 609.9000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 12.000000 863.5200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 4 8.000000 495.0600 61.8825
PHY-97110-PT SESSION BY LICENSED PT 13 124.750000 9942.1200 79.6964
PHY-97110HM-PT SESSION BY PT ASST 6 55.500000 2607.6400 46.9845
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 440.500000 31915.0400 72.4519
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 62.000000 3628.2000 58.5194
Subtotal (Total Children Is Unduplicated) 89 1309.500000 94458.9700 72.1336
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Total 1356.500000 97132.0900 71.6049
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Number of Children (Unduplicated) With at Least One Service 93
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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 1744 1288.250000 92375.7600 91239.1900
104 67.500000 4725.1700 0.0000
Other 1 0.750000 31.1600 31.1600
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Total 1849 1356.500000 97132.0900 91270.3500