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
Agency Filter:EXT
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 311 504.250000 18720.9000 37.1262
Subtotal (Total Children Is Unduplicated) 311 504.250000 18720.9000 37.1262
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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 263 529.000000 26450.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 20.500000 1576.3700 76.8961
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 16.500000 1336.1700 80.9800
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 25 49.500000 3828.8600 77.3507
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 596.8800 74.6100
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 311.9600 77.9900
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 20 35.000000 2046.3700 58.4677
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 25 47.000000 2752.1500 58.5564
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 172 330.000000 25865.2700 78.3796
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 234 443.000000 35601.8000 80.3652
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 191 372.500000 29390.6400 78.9010
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 518 961.000000 76192.9600 79.2851
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 90 177.500000 13913.2300 78.3844
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 64 125.500000 9944.4700 79.2388
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 308 553.500000 32625.7000 58.9444
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 510 910.000000 53582.4300 58.8818
NUTR-97802-NUTRITIONAL EVAL, INITIAL 31 314.000000 15700.0000 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 8 8.000000 464.8800 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 174.3300 58.1100
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-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 10.000000 581.1000 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 174.3300 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 53 1559.000000 85187.1200 54.6422
Subtotal (Total Children Is Unduplicated) 1823 7422.500000 466557.8500 62.8572
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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 583 1215.000000 60325.0000 49.6502
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 6 11.000000 550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 284 360.000000 9000.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 97 133.000000 6650.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 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
CONOP-CONOP-CONSULT, OT, PHONE 6 5.250000 131.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 59 71.000000 3550.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 4.000000 50.0000 12.5000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 87 100.250000 5012.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 5.500000 137.5000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 6.000000 324.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2370 41176.00000 2177690.9600 52.8874
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 140 321.250000 16820.5000 52.3595
EPIC-99601-Early Steps Professional Development Fee 1859 38113.00000 263451.0000 6.9124
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 616 7883.000000 93408.0000 11.8493
OCCT-97530-OT SESSION BY LICENSED OT 256 4094.000000 321474.8600 78.5234
OCCT-97530GO-OT SESSION BY LICENSED OT 5 30.500000 2480.2600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 8.000000 603.7600 75.4700
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
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
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 523 9773.500000 762515.8800 78.0187
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 41.000000 3259.2400 79.4937
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 32.000000 1880.8000 58.7750
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 2652 685409.0000 304726.6500 0.4446
Subtotal (Total Children Is Unduplicated) 2804 796791.2500 4648641.2200 5.8342
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Total 804718.000000 5133919.9700 6.3798
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Number of Children (Unduplicated) With at Least One Service 3152
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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 138716 740145.000000 3305723.2700 3305795.2300
D 889 4098.250000 28055.4100 0.0000
S 292 663.000000 10331.6400 0.0000
H 941 1509.500000 88409.8800 0.0000
T 3383 13961.750000 90135.9700 90135.9700
28777 43662.000000 1561857.7800 762709.2700
Other 353 678.500000 49406.0200 0.0000
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Total 173351 804718.000000 5133919.9700 4158640.4700