CMS/EIP Fiscal Report Center: 09
Services beginning 04/01/2025 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 1260 2852.250000 106103.7000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1624 6016.250000 223860.3000 37.2093
Subtotal (Total Children Is Unduplicated) 1794 8868.500000 329964.0000 37.2063
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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 210 360.000000 18000.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 526.3700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 445.3900 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.500000 769.3100 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.000000 404.9000 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.000000 719.0400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 17.500000 1048.6000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 71 122.500000 9920.0500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 104 195.500000 15831.5900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 73 136.000000 10962.3200 80.6053
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 164 308.000000 24899.7200 80.8432
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 75.500000 6113.9900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 54.000000 4372.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 174 313.500000 18784.9200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 260 482.000000 29007.8000 60.1822
NUTR-97802-NUTRITIONAL EVAL, INITIAL 19 107.000000 5350.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 21 175.000000 8750.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 232.4400 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 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 4 8.000000 488.0900 61.0113
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 26 237.000000 13677.7300 57.7119
Subtotal (Total Children Is Unduplicated) 737 2651.000000 171626.2400 64.7402
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 181 333.250000 16587.5000 49.7749
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 30.500000 1525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 80 98.500000 2462.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 35 47.000000 2400.0000 51.0638
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 38.000000 1904.0000 50.1053
CONOP-CONOP-CONSULT, OT, PHONE 2 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 14.000000 700.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 20.000000 1000.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 59 119.000000 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 1326 8966.500000 483603.0000 53.9344
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 46.000000 2484.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1073 9140.000000 63405.0000 6.9371
INTR-T1013-INTERPRETER 90 407.000000 20200.0000 49.6314
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 242 1428.000000 16992.0000 11.8992
OCCT-97530-OT SESSION BY LICENSED OT 155 1034.000000 84084.8800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 9 48.250000 3923.6900 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 32 257.000000 15730.7800 61.2093
OCCT-97530HMGT-OT SESSION BY OT ASST 2 10.000000 651.2000 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 217 1728.250000 140284.8900 81.1716
PHY-97110GP-PT SESSION BY LICENSED PT 1 2.250000 182.9700 81.3200
PHY-97110HM-PT SESSION BY PT ASST 9 51.000000 3321.1200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 297 2375.500000 191177.8300 80.4790
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 26.000000 2114.3200 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 9.000000 731.8800 81.3200
TRAV-TRAVS-Travel by mile 1485 156617.0000 69664.2900 0.4448
Subtotal (Total Children Is Unduplicated) 1664 182860.2500 1125944.1400 6.1574
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Total 194379.750000 1627534.3800 8.3730
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Number of Children (Unduplicated) With at Least One Service 2137
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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 31400 150626.250000 851464.2900 851464.2900
D 227 521.500000 8716.6400 0.0000
S 292 663.000000 10331.6400 0.0000
H 2389 3039.500000 136256.8700 114958.5300
T 4155 14232.000000 125295.7400 125295.7400
10417 25082.500000 480343.5100 0.0000
Other 113 215.000000 15125.6900 0.0000
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Total 48993 194379.750000 1627534.3800 1091718.5600