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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 4 8.000000 600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 485.8800 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 2 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 440.5600 58.7413
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 581.5200 58.1520
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 40.000000 3011.9600 75.2990
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2423.9200 75.7475
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 42.000000 3269.6000 77.8476
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 711.0000 71.1000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 923.9200 76.9933
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 24.500000 1417.2100 57.8453
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 50.000000 2895.7700 57.9154
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 2 2.000000 116.2200 58.1100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
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 1 1.000000 58.1100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 28 604.000000 32735.8700 54.1985
Subtotal (Total Children Is Unduplicated) 139 884.000000 52114.1000 58.9526
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 3498.0000 874.5000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 54.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 104 586.000000 30726.0000 52.4334
EPIC-99601-Early Steps Professional Development Fee 2 13.000000 39.0000 3.0000
OCCT-97530-OT SESSION BY LICENSED OT 122 1359.500000 107756.2300 79.2617
OCCT-97530GO-OT SESSION BY LICENSED OT 2 10.750000 874.1900 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 153.2800 76.6400
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 286 3908.750000 302982.7100 77.5140
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 569.2400 81.3200
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) 529 9082.000000 685974.0900 75.5312
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Total 9966.000000 738088.1900 74.0606
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Number of Children (Unduplicated) With at Least One Service 592
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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 9411 9251.000000 680662.1000 680734.0600
D 57 57.000000 2904.2400 0.0000
S 1 2.000000 161.9600 0.0000
H 0 0.000000 0.0000 0.0000
T 224 214.250000 17230.2100 17230.2100
440 436.250000 36734.4700 16517.1400
Other 3 5.500000 395.2100 0.0000
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Total 10136 9966.000000 738088.1900 714481.4100