CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2132 1577.250000 58803.9000 37.2825
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17 11.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3383 23214.50000 863653.8000 37.2032
Subtotal (Total Children Is Unduplicated) 3394 24803.50000 922457.7000 37.1906
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 2 2.000000 117.8100 58.9050
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 16.1500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 9.000000 71.2800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 8.000000 254.4800 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 45.5700 15.1900
AUDE-V5010-ASSESSMENT FOR HEARING AID 6 8.000000 274.4400 34.3050
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.8100 115.8100
EXIT-EXIT-COS Exit 392 369.250000 18258.7500 49.4482
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 13.000000 1034.8000 79.6000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 10.000000 791.8600 79.1860
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 13.000000 1034.8000 79.6000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 11.500000 919.3100 79.9400
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 6.500000 499.4600 76.8400
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 5.500000 445.3900 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 11.500000 660.4000 57.4261
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 9.500000 555.9800 58.5242
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 343 438.000000 34438.3600 78.6264
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 347 479.000000 37870.1100 79.0608
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 295 390.500000 30684.2300 78.5768
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 297 435.000000 34366.8600 79.0043
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 141 185.000000 14596.9600 78.9025
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 156 230.000000 18089.1500 78.6485
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 335 447.500000 26140.7000 58.4150
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 381 567.500000 33320.4500 58.7144
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 1558 3662.250000 254954.1600 69.6168
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EI Services,Class #03
AUD-92630-AUD REHAB PRELING HEARING LOSS 4 5.000000 324.7500 64.9500
AUDE-V5160-DISPENSING FEE BINAURAL 2 2.000000 461.2400 230.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 291 330.500000 16224.4200 49.0905
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 999 1008.500000 49950.0000 49.5290
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 152 152.000000 3700.0000 24.3421
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 26.500000 1325.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 15 26.750000 1287.5000 48.1308
CONIP-CONIP-CONSULT, ITDS PHONE 5 8.750000 218.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 10.000000 500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 12 27.500000 1375.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 8 10.250000 275.0000 26.8293
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 15.000000 725.0000 48.3333
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 5 7.000000 331.2500 47.3214
CONPP-CONPP-CONSULT, PT, PHONE 1 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1612 27487.75000 1451868.6000 52.8188
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 463 4272.750000 224708.5000 52.5911
EPIC-99601-Early Steps Professional Development Fee 1081 15979.00000 238134.0000 14.9029
INTR-T1013-INTERPRETER 137 1691.500000 111350.0000 65.8291
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 918 13371.00000 157554.0000 11.7833
OCCT-97530-OT SESSION BY LICENSED OT 19 194.750000 12518.4000 64.2793
OCCT-97530GO-OT SESSION BY LICENSED OT 3 5.500000 428.5400 77.9164
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 10.750000 541.1600 50.3405
OCCT-97530GT-OT SESSION BY LICENSED OT 9 93.000000 6489.6800 69.7815
OCCT-97530HM-OT SESSION BY OT ASST 4 30.500000 1594.1600 52.2675
OCCT-97530HMGT-OT SESSION BY OT ASST 5 38.750000 2389.2500 61.6581
PHY-97110-PT SESSION BY LICENSED PT 33 729.750000 53029.4000 72.6679
PHY-97110GT-PT SESSION BY LICENSED PT 9 74.500000 5246.1800 70.4185
PHY-97110HM-PT SESSION BY PT ASST 18 271.000000 16015.4800 59.0977
PHY-97110HMGT-PT SESSION BY PT ASST 13 118.750000 6761.6000 56.9398
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 459.2200 459.2200
SENS-V5264-EARMOLD 10 27.000000 507.6400 18.8015
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 88 1025.750000 78110.7800 76.1499
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 51 455.750000 34966.7800 76.7236
Subtotal (Total Children Is Unduplicated) 2152 67521.00000 2479808.7800 36.7265
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Total 95986.750000 3657220.6400 38.1013
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Number of Children (Unduplicated) With at Least One Service 3422
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Center 06
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 44188 44781.000000 1310755.7400 1310755.7400
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 0 0.000000 0.0000 0.0000
63977 50931.750000 2335347.3100 0.0000
Other 518 274.000000 11117.5900 0.0000
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Total 108683 95986.750000 3657220.6400 1310755.7400