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: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 3672 17797.25000 662691.8400 37.2356
TCM-T1017TL-TARGETED CASE MANAGEMENT 4197 31555.75000 1173845.3100 37.1991
Subtotal (Total Children Is Unduplicated) 4355 49353.00000 1836537.1500 37.2123
-----------------------------------------------------------------------------------------------------------------------
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 32 54.500000 4317.7300 79.2244
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 21 39.000000 3125.3300 80.1367
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 31.000000 2393.7700 77.2184
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 45 89.000000 6937.8700 77.9536
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 16 29.500000 2290.1100 77.6308
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 14.500000 1150.2900 79.3303
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 51 91.500000 5343.4500 58.3984
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 65 122.500000 7172.2400 58.5489
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 487 853.000000 67021.6800 78.5717
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 516 929.500000 74310.3600 79.9466
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 379 718.000000 56696.3500 78.9643
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 923 1687.000000 133515.8400 79.1439
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 216 407.000000 32157.2800 79.0105
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 155 297.000000 23695.0000 79.7811
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 929 1677.000000 98332.0000 58.6357
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1417 2553.500000 151069.6400 59.1618
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) 3419 14105.50000 903292.4300 64.0383
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 4.000000 3498.0000 874.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 604 1273.750000 63262.5000 49.6663
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 116 631.750000 331.8000 0.5252
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 6.000000 324.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2429 41826.25000 2212099.4600 52.8878
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 154 371.250000 19484.5000 52.4835
EPIC-99601-Early Steps Professional Development Fee 1861 38144.00000 263916.0000 6.9189
INTR-T1013-INTERPRETER 336 1676.500000 83675.0000 49.9105
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 617 7884.000000 93420.0000 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:Program Patients
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 2674 686721.0000 305310.3800 0.4446
Subtotal (Total Children Is Unduplicated) 2990 801928.0000 4826036.5000 6.0180
-----------------------------------------------------------------------------------------------------------------------
Total 865386.500000 7565866.0800 8.7428
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 4584
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 176768 780405.750000 4846978.4800 4834940.1900
D 899 4170.750000 28249.3300 0.0000
S 300 678.500000 11544.7100 0.0000
H 15836 18738.750000 837527.1800 699273.5300
T 4379 15041.500000 134966.9400 134966.9400
30303 45455.750000 1641487.1500 775780.4800
Other 470 895.500000 65112.2900 0.0000
---------------------------------------------------------
Total 228955 865386.500000 7565866.0800 6444961.1400