CMS/EIP Fiscal Report Center: 07
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 4191 10414.75000 386975.0000 37.1564
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 429 559.500000 74.4000 0.1330
TCM-T1017TL-TARGETED CASE MANAGEMENT 3958 14965.25000 556449.1500 37.1828
Subtotal (Total Children Is Unduplicated) 4419 25939.50000 943498.5500 36.3730
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Screening, Eval, and Assessment,Class #02
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 61.7100 61.7100
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.8400 15.8400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 111.5800 15.9400
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 5 9.000000 218.5200 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 47 51.000000 417.2700 8.1818
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 42 45.000000 1399.6600 31.1036
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 18 18.000000 269.2800 14.9600
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 10 10.000000 229.3000 22.9300
EXIT-EXIT-COS Exit 391 436.000000 22850.0000 52.4083
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 22.000000 1721.7600 78.2618
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 20.000000 1543.7200 77.1860
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 20.000000 1595.6800 79.7840
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 16.000000 1259.8043 78.7378
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 28.000000 2219.6000 79.2714
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 10.000000 797.8400 79.7840
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 28 56.000000 3201.5500 57.1705
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 14 28.000000 1642.4000 58.6571
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 647.8400 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 272 543.000000 41694.9727 76.7863
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 204 408.000000 31536.1100 77.2944
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 275 550.000000 43667.5089 79.3955
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 126 252.000000 19952.4800 79.1765
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 233 466.000000 36911.4595 79.2091
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 88 176.000000 14013.2893 79.6210
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 567 1134.000000 66808.9200 58.9144
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 348 696.000000 40873.3600 58.7261
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 238 481.000000 37568.2782 78.1045
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 120 240.000000 18479.7330 76.9989
OCTF-97168-OT RE-EVAL EST PLAN CARE 18 20.000000 1056.0400 52.8020
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 285.9000 47.6500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 40 40.000000 2212.1700 55.3043
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 7.000000 386.6700 55.2386
OCTH-97167-OT EVAL HIGH COMPLEXITY 13 13.000000 701.1800 53.9369
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
PSTF-97164-PT RE-EVAL EST PLAN CARE 31 48.000000 2642.8800 55.0600
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 283.8300 47.3050
PSTH-97162-PT EVAL MODERATE COMPLEXITY 11 11.000000 529.8500 48.1682
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 13 13.000000 735.3300 56.5638
SCREEN-T1023-SCREENING 10 10.000000 531.8400 53.1840
SPCH-92521-EVAL OF SPEECH FLUENCY 31 32.000000 1714.2400 53.5700
SPCH-92521GT-EVAL OF SPEECH FLUENCY 4 4.000000 232.4400 58.1100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 90 100.000000 5505.0500 55.0505
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 554.3000 55.4300
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 8 10.000000 543.2100 54.3210
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 20.2200 20.2200
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 22 271.000000 13578.3900 50.1048
Subtotal (Total Children Is Unduplicated) 1856 6342.000000 423713.8959 66.8108
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 6.000000 8025.1200 1337.5200
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 69.3500 69.3500
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 275 296.500000 14825.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 650 938.000000 46900.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 88 85.500000 2137.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 560 1664.750000 83237.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 550 2204.000000 110137.5000 49.9716
CONIP-CONIP-CONSULT, ITDS PHONE 12 12.250000 306.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 272 573.750000 28687.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 283 811.000000 40525.0000 49.9692
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 106 268.250000 13412.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 111 352.500000 17625.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 5.500000 137.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 327 805.250000 40262.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 313 835.000000 41750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 17 23.000000 575.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 352 613.000000 150.0000 0.2447
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1083 19583.00000 1035767.0000 52.8911
CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 2
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 267 1233.250000 65336.5000 52.9791
EPIC-99601-Early Steps Professional Development Fee 1394 24219.00000 363471.0000 15.0077
INTR-T1013-INTERPRETER 2 11.750000 902.8000 76.8340
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2079 40583.00000 487569.0000 12.0141
OCCT-97530-OT SESSION BY LICENSED OT 122 1760.750000 129875.4400 73.7614
OCCT-97530GO-OT SESSION BY LICENSED OT 2 3.000000 154.8000 51.6000
OCCT-97530GOGT-OT SESSION BY LICENSED OT 4 8.000000 641.2000 80.1500
OCCT-97530GT-OT SESSION BY LICENSED OT 10 95.000000 7053.2800 74.2451
OCCT-97530HM-OT SESSION BY OT ASST 15 110.000000 6967.8400 63.3440
OCCT-97530HMGT-OT SESSION BY OT ASST 3 3.000000 195.3600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 99 1806.250000 135880.1700 75.2278
PHY-97110GT-PT SESSION BY LICENSED PT 10 45.250000 3308.6300 73.1189
PHY-97110HM-PT SESSION BY PT ASST 1 20.000000 1241.9200 62.0960
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
SENS-V5264-EARMOLD 7 23.000000 416.9900 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 244 3656.000000 269970.9200 73.8432
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 72.250000 5532.1700 76.5698
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 21 311.500000 17845.3100 57.2883
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 13 190.750000 11637.3500 61.0084
TRAV-TRAVS-Travel by mile 157 17217.00000 7663.5200 0.4451
Subtotal (Total Children Is Unduplicated) 2856 120452.0000 3001481.7800 24.9185
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Total 152733.500000 4368694.2259 28.6034
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Number of Children (Unduplicated) With at Least One Service 4595
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Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 171.2600 0.0000
U 0 0.000000 0.0000 0.0000
B 575 501.500000 23860.6000 0.0000
P 117413 132045.059400 3579493.6086 3574740.9900
D 434 448.250000 27496.5500 0.0000
S 0 0.000000 0.0000 0.0000
H 75 147.000000 11713.7200 323.9200
T 0 0.000000 0.0000 0.0000
33731 19370.690600 719031.0973 58.1100
Other 688 218.750000 6927.3900 -2251.7100
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Total 152918 152733.500000 4368694.2259 3572871.3100