CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3193 16769.50000 624459.5400 37.2378
TCM-T1017TL-TARGETED CASE MANAGEMENT 3465 29231.00000 1087346.0100 37.1984
Subtotal (Total Children Is Unduplicated) 3618 46000.50000 1711805.5500 37.2128
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Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 3.000000 347.4300 115.8100
EXIT-EXIT-COS Exit 945 1661.000000 83050.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 40.000000 3143.5200 78.5880
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 15 28.000000 2255.4800 80.5529
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 27.000000 2081.8100 77.1041
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 32 64.500000 5019.6400 77.8239
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 16.500000 1273.2500 77.1667
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.000000 866.8600 78.8055
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 37 67.000000 3901.9300 58.2378
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 46 86.500000 5065.9500 58.5659
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 366 661.000000 51954.9100 78.6005
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 362 672.000000 53793.4000 80.0497
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 277 530.000000 41809.9800 78.8868
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 624 1160.500000 91968.7400 79.2492
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 152 290.000000 22870.9900 78.8655
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 109 216.000000 17213.3600 79.6915
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 675 1242.000000 72663.5600 58.5053
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 960 1774.500000 104961.3000 59.1498
NUTR-97802-NUTRITIONAL EVAL, INITIAL 31 315.000000 15750.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 56 884.000000 44200.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 335.2600 55.8767
OCTH-97166-OT EVAL MODERATE COMPLEXITY 18 19.000000 1143.8100 60.2005
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 225.7400 56.4350
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 283.8500 56.7700
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 6.000000 335.2600 55.8767
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SPCH-92522TLGT-EVAL OF SPCH SOUND PROD 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 25.000000 1472.3700 58.8948
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 464.8800 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 55 1564.000000 85477.6700 54.6532
Subtotal (Total Children Is Unduplicated) 2656 11398.50000 714608.1700 62.6932
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 3498.0000 874.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 602 1268.750000 63012.5000 49.6650
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 53 85.000000 4250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 309 395.750000 9893.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 104 140.000000 7000.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 9.000000 225.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 98 110.500000 5529.0000 50.0362
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 6 5.250000 131.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 63 76.000000 3800.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 4.000000 50.0000 12.5000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 98 114.250000 5712.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 10 11.000000 550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 6.500000 162.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 114 628.750000 331.8000 0.5277
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 6.000000 324.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2427 41779.25000 2209633.4600 52.8883
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 154 371.250000 19484.5000 52.4835
EPIC-99601-Early Steps Professional Development Fee 1859 38113.00000 263451.0000 6.9124
INTR-T1013-INTERPRETER 292 1487.500000 74225.0000 49.8992
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 616 7883.000000 93408.0000 11.8493
OCCT-97530-OT SESSION BY LICENSED OT 263 4147.000000 325738.0200 78.5479
OCCT-97530GO-OT SESSION BY LICENSED OT 12 68.250000 5531.3700 81.0457
OCCT-97530GOGT-OT SESSION BY LICENSED OT 8 11.000000 829.0000 75.3636
OCCT-97530GT-OT SESSION BY LICENSED OT 12 19.000000 1395.3200 73.4379
OCCT-97530HM-OT SESSION BY OT ASST 51 775.000000 48215.4100 62.2134
OCCT-97530HMGT-OT SESSION BY OT ASST 2 10.000000 651.2000 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 4 49.000000 3975.3200 81.1290
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 330 6966.250000 548042.9600 78.6712
PHY-97110GP-PT SESSION BY LICENSED PT 1 2.250000 182.9700 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.000000 234.6000 78.2000
PHY-97110HM-PT SESSION BY PT ASST 9 103.000000 6707.3600 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 2 4.000000 260.4800 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 459.2200 229.6100
CMS/EIP Fiscal Report Center: 09
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 551 10137.50000 791379.4500 78.0646
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 56.000000 4450.9600 79.4814
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 32.000000 1880.8000 58.7750
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 5 28.000000 2276.9600 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 569.2400 81.3200
TRAV-TRAVS-Travel by mile 2652 685409.0000 304726.6500 0.4446
Subtotal (Total Children Is Unduplicated) 2923 800340.0000 4812809.7700 6.0135
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Total 857739.000000 7239223.4900 8.4399
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Number of Children (Unduplicated) With at Least One Service 3807
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Center 09
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 174265 775886.250000 4692237.1300 4683050.3400
D 890 4100.750000 28148.4100 0.0000
S 292 663.000000 10331.6400 0.0000
H 14280 16369.500000 710572.8200 619726.7800
T 4334 14970.750000 131251.4800 131251.4800
30058 45062.250000 1616763.3500 762709.2700
Other 357 686.500000 49918.6600 0.0000
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Total 224476 857739.000000 7239223.4900 6196737.8700