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
Payclass Filters:GR
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 2002 5255.750000 195209.0000 37.1420
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 146 247.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 869 3266.000000 121393.9000 37.1690
Subtotal (Total Children Is Unduplicated) 2082 8769.250000 316602.9000 36.1038
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 15.8400 15.8400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 46.9800 15.6600
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 11 14.000000 118.8900 8.4921
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 12.000000 364.3800 30.3650
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 42.8100 14.2700
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 5.000000 113.6000 22.7200
EXIT-EXIT-COS Exit 354 398.750000 20950.0000 52.5392
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 311.9600 77.9900
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 445.8800 74.3133
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.101700 401.1800 78.6365
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 15 30.000000 1753.4000 58.4467
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 16.000000 949.8800 59.3675
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 36.365500 2224.1875 61.1620
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 19.152800 1360.3800 71.0277
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 21.511700 1512.8361 70.3262
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 18.986500 1453.8068 76.5706
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 33.443900 2523.2000 75.4457
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 8.952800 707.3400 79.0077
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 85 170.000000 9726.7200 57.2160
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 41 82.000000 4674.7600 57.0093
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 28.826800 2052.8400 71.2129
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.224000 1378.7500 71.7202
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 8.000000 358.7200 44.8400
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 60.1600 30.0800
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 488.9700 48.8970
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 4.000000 212.3400 53.0850
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 225.7400 56.4350
PSTF-97164-PT RE-EVAL EST PLAN CARE 20 31.000000 1675.1100 54.0358
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 122.9000 40.9667
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 180.5700 45.1425
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 16 16.000000 811.2800 50.7050
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 20.000000 996.9500 49.8475
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 277.1500 55.4300
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 90.000000 3323.3000 36.9256
Subtotal (Total Children Is Unduplicated) 582 1160.315700 63776.4104 54.9647
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 4030.3900 1007.5975
AUD-92630-AUD REHAB PRELING HEARING LOSS 1 1.000000 69.3500 69.3500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 236 260.000000 13000.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 569 853.250000 42662.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 77 77.000000 1925.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 469 1444.500000 72225.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 477 2023.250000 101100.0000 49.9691
CONIP-CONIP-CONSULT, ITDS PHONE 10 10.750000 268.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 231 510.500000 25525.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 240 723.500000 36150.0000 49.9654
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 88 232.500000 11625.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 98 329.000000 16450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 5.500000 137.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 293 734.250000 36712.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 282 778.500000 38925.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 17 23.000000 575.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 111 202.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 693 13727.75000 721056.9000 52.5255
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 199 862.250000 45326.5000 52.5677
EPIC-99601-Early Steps Professional Development Fee 951 19578.00000 293790.0000 15.0061
INTR-T1013-INTERPRETER 1 11.250000 877.8000 78.0267
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1388 32541.00000 390208.0000 11.9913
OCCT-97530-OT SESSION BY LICENSED OT 64 707.000000 47846.3700 67.6752
OCCT-97530GO-OT SESSION BY LICENSED OT 2 2.000000 81.2800 40.6400
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
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
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530GT-OT SESSION BY LICENSED OT 4 44.000000 2966.8000 67.4273
OCCT-97530HM-OT SESSION BY OT ASST 1 9.000000 586.0800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 52 851.500000 61400.4400 72.1086
PHY-97110GT-PT SESSION BY LICENSED PT 3 12.750000 778.0500 61.0235
PHY-97110HM-PT SESSION BY PT ASST 1 20.000000 1241.9200 62.0960
SENS-V5264-EARMOLD 1 4.000000 72.5200 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 99 1129.500000 72215.0400 63.9354
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 20.250000 1490.7300 73.6163
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 196.500000 10908.7900 55.5155
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 10 135.750000 8085.8300 59.5641
TRAV-TRAVS-Travel by mile 96 14529.00000 6467.6900 0.4452
Subtotal (Total Children Is Unduplicated) 1863 92598.75000 2066928.6900 22.3213
-----------------------------------------------------------------------------------------------------------------------
Total 102528.315700 2447308.0004 23.8696
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2306
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 79824 93260.750000 2111135.3800 2111135.3800
D 218 143.250000 5548.2000 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
16897 9153.315700 332272.6604 0.0000
Other 38 -29.000000 -1648.2400 -1648.2400
---------------------------------------------------------
Total 96977 102528.315700 2447308.0004 2109487.1400