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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2350 1689.500000 62970.3000 37.2716
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 23 14.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3769 25046.25000 931813.5000 37.2037
Subtotal (Total Children Is Unduplicated) 3781 26750.50000 994783.8000 37.1875
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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 15 20.000000 1601.6600 80.0830
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 15.500000 1237.2500 79.8226
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 17.500000 1393.2300 79.6131
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 14.500000 1162.2500 80.1552
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 10.500000 823.3800 78.4171
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 7.000000 566.8600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 15 18.000000 1045.4600 58.0811
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 450 562.000000 44194.2100 78.6374
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 460 629.500000 49770.5600 79.0636
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 405 527.500000 41446.6000 78.5718
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 380 549.500000 43319.1400 78.8337
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 188 242.000000 19055.7200 78.7426
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 203 297.000000 23371.2900 78.6912
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 426 559.500000 32734.0900 58.5060
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 470 688.500000 40382.9200 58.6535
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) 1919 4577.250000 322165.9400 70.3842
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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 158 1737.500000 115110.0000 66.2504
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) 2173 67567.00000 2483568.7800 36.7571
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Total 98894.750000 3800518.5200 38.4299
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Number of Children (Unduplicated) With at Least One Service 3810
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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 44208 44821.000000 1314095.7400 1314095.7400
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
67093 53778.750000 2474348.8700 0.0000
Other 540 295.000000 12073.9100 0.0000
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Total 111841 98894.750000 3800518.5200 1314095.7400