CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2025 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
Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EXIT-EXIT-COS Exit 15 15.000000 750.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.500000 1255.1900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 24.000000 1438.0800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 43.500000 3522.6300 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 86.1700 43.0850
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 58 131.000000 9291.5800 70.9281
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 29.000000 1450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 16 27.500000 1375.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 33 33.750000 1687.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 31 31.500000 1575.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 14 11.250000 562.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 2.000000 100.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 14 13.500000 675.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 587.000000 31698.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 51.500000 2781.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 270 1802.000000 27030.0000 15.0000
INTR-T1013-INTERPRETER 26 83.250000 4162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 109 582.000000 6984.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 38 200.000000 15229.4100 76.1471
OCCT-97530GO-OT SESSION BY LICENSED OT 1 6.250000 508.2500 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 2.500000 136.9000 54.7600
PHY-97110-PT SESSION BY LICENSED PT 13 47.500000 3842.3700 80.8920
PHY-97110HM-PT SESSION BY PT ASST 6 11.750000 350.3100 29.8136
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 155.250000 11582.5000 74.6055
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 10.000000 813.2000 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 21.750000 1219.8000 56.0828
TRAV-TRAVS-Travel by mile 99 4850.000000 2157.8800 0.4449
Subtotal (Total Children Is Unduplicated) 454 8567.250000 117250.7600 13.6859
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Total 8698.250000 126542.3400 14.5480
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Number of Children (Unduplicated) With at Least One Service 464
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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 2452 5602.750000 78087.4800 77933.2900
1644 3095.500000 48454.8600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4096 8698.250000 126542.3400 77933.2900