CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2025 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 1801 2476.250000 92135.1000 37.2075
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 112 130.250000 74.4000 0.5712
TCM-T1017TL-TARGETED CASE MANAGEMENT 1675 3813.500000 141787.8000 37.1805
Subtotal (Total Children Is Unduplicated) 2031 6420.000000 233997.3000 36.4482
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Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 23.1400 23.1400
EXIT-EXIT-COS Exit 141 161.250000 8600.0000 53.3333
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
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 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 719.0400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
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 79 158.000000 12393.0900 78.4373
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 47 94.000000 7431.7300 79.0610
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 148.000000 11845.0400 80.0341
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 42.000000 3401.1600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 126.000000 10203.4800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 14 28.000000 2267.4400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 183 366.000000 21930.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 56 112.000000 6711.0400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 130.000000 10360.9300 79.6995
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 36.000000 2877.7800 79.9383
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 8.000000 464.8800 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 871.6500 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 11 11.000000 586.6100 53.3282
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 290.5500 58.1100
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 7 7.000000 337.1300 48.1614
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 987.8700 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 4 5.000000 290.5500 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 13 69.000000 3453.4900 50.0506
Subtotal (Total Children Is Unduplicated) 560 1595.250000 109082.7700 68.3797
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 547.0600 273.5300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 69 68.250000 3412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 182 210.000000 10500.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 10.500000 262.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 207 349.750000 17487.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 249 470.000000 23500.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 87 116.500000 5825.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 117 182.250000 9112.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 38 55.000000 2750.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 52 72.500000 3625.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 113 155.500000 7775.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 122 181.250000 9062.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 94 160.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 607 4571.750000 246701.7000 53.9622
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 88 254.750000 13756.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 789 5762.000000 86415.0000 14.9974
INTR-T1013-INTERPRETER 1 2.000000 161.7000 80.8500
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1028 8671.000000 103927.0000 11.9856
OCCT-97530-OT SESSION BY LICENSED OT 60 361.000000 26963.9400 74.6924
OCCT-97530GT-OT SESSION BY LICENSED OT 3 24.000000 1608.1200 67.0050
OCCT-97530HM-OT SESSION BY OT ASST 8 39.000000 2539.6800 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 65.1200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 55 337.500000 25828.2000 76.5280
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.750000 223.6300 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 7.000000 455.8400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 111 765.750000 57915.3100 75.6321
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 12.750000 899.5500 70.5529
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 12 91.000000 4901.0300 53.8575
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 5 16.000000 946.9300 59.1831
TRAV-TRAVS-Travel by mile 51 3843.000000 1709.5600 0.4449
Subtotal (Total Children Is Unduplicated) 1612 26800.00000 668965.8700 24.9614
CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2025 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
-----------------------------------------------------------------------------------------------------------------------
Total 34815.250000 1012045.9400 29.0690
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Number of Children (Unduplicated) With at Least One Service 2459
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Center 07
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 436 392.750000 19551.5800 0.0000
P 26177 29462.250000 802727.5800 801791.0500
D 52 31.000000 1591.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 49 98.000000 7936.0400 323.9200
T 0 0.000000 0.0000 0.0000
8062 4752.500000 177730.3200 0.0000
Other 218 78.750000 2509.4200 -457.2800
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Total 34994 34815.250000 1012045.9400 801657.6900