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
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
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 390 367.500000 18171.2500 49.4456
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 402 404.500000 19233.9900 47.5500
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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 249 284.500000 13914.5000 48.9086
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 239 294.500000 14250.0000 48.3871
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 147 149.000000 3625.0000 24.3289
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 26.500000 1325.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 14 26.500000 1275.0000 48.1132
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 11 27.000000 1350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 9.250000 250.0000 27.0270
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 12 120.000000 6491.2100 54.0934
OCCT-97530GO-OT SESSION BY LICENSED OT 2 4.000000 306.5600 76.6400
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 10.750000 541.1600 50.3405
OCCT-97530GT-OT SESSION BY LICENSED OT 8 91.500000 6381.7400 69.7458
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 80 935.500000 71031.3900 75.9288
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 46 421.750000 32323.5800 76.6416
Subtotal (Total Children Is Unduplicated) 1966 66554.25000 2425681.6600 36.4467
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Total 66958.750000 2444915.6500 36.5138
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Number of Children (Unduplicated) With at Least One Service 1974
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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
22081 22177.750000 1134159.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 66269 66958.750000 2444915.6500 1310755.7400