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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 8 9.250000 344.1000 37.2000
Subtotal (Total Children Is Unduplicated) 8 9.250000 344.1000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 3.000000 347.4300 115.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 15.000000 1154.9000 76.9933
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 11.500000 931.2700 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 12.000000 947.8400 78.9867
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 242.9400 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 3.500000 271.4700 77.5629
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 13.000000 752.4400 57.8800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 25.500000 1492.6000 58.5333
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 90.000000 6785.7500 75.3972
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 20.000000 1577.7400 78.8870
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 52.500000 3997.3000 76.1390
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 39 75.500000 5809.0100 76.9405
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 19.500000 1432.4700 73.4600
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1385.8800 76.9933
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 108.500000 6117.3000 56.3806
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 61 118.000000 6810.4300 57.7155
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 5.000000 250.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 9.000000 569.4100 63.2678
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 109.5200 54.7600
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 109.5200 54.7600
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 12.000000 700.4300 58.3692
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 29 608.000000 32968.3100 54.2242
Subtotal (Total Children Is Unduplicated) 208 1240.500000 75631.6600 60.9687
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 3498.0000 874.5000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.250000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 54.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 108 590.000000 30930.0000 52.4237
EPIC-99601-Early Steps Professional Development Fee 2 13.000000 39.0000 3.0000
OCCT-97530-OT SESSION BY LICENSED OT 129 1410.500000 111875.4700 79.3162
OCCT-97530GO-OT SESSION BY LICENSED OT 8 42.500000 3437.3800 80.8795
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 5.000000 387.8800 77.5760
OCCT-97530GT-OT SESSION BY LICENSED OT 5 7.000000 513.0800 73.2971
OCCT-97530HM-OT SESSION BY OT ASST 22 217.000000 13664.8000 62.9714
PHY-97110-PT SESSION BY LICENSED PT 177 2835.750000 222412.1500 78.4315
PHY-97110GP-PT SESSION BY LICENSED PT 1 2.250000 182.9700 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 19.000000 1237.2800 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 459.2200 229.6100
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 304 4225.750000 328080.4000 77.6384
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 9.000000 722.5200 80.2800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 17.000000 979.2000 57.6000
TRAV-TRAVS-Travel by mile 3 91.000000 40.4800 0.4448
Subtotal (Total Children Is Unduplicated) 551 9496.000000 718615.2100 75.6756
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Total 10745.750000 794590.9700 73.9447
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Number of Children (Unduplicated) With at Least One Service 644
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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 9871 9799.500000 720882.1000 713887.5600
D 57 57.000000 2904.2400 0.0000
S 1 2.000000 161.9600 0.0000
H 133 200.750000 13975.9400 13864.9400
T 230 221.250000 17733.4400 17733.4400
465 459.750000 38538.0800 16517.1400
Other 3 5.500000 395.2100 0.0000
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Total 10760 10745.750000 794590.9700 762003.0800