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
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 70 111.000000 4129.2000 37.2000
Subtotal (Total Children Is Unduplicated) 70 111.000000 4129.2000 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
EXIT-EXIT-COS Exit 67 136.000000 6800.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 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 4 7.500000 607.3500 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 479.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.000000 539.2800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 43.500000 3522.6300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 73 137.000000 11094.2600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 88.500000 7166.7300 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 125 240.500000 19433.5700 80.8049
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 21.000000 1700.5800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 931.2700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 153.500000 9197.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 121 216.000000 13026.9600 60.3100
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 2 2.000000 116.2200 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-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 6.000000 348.6600 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 24 232.000000 13387.1800 57.7034
Subtotal (Total Children Is Unduplicated) 491 1612.000000 103876.6800 64.4396
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 180 331.250000 16487.5000 49.7736
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 72 88.500000 2212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 34 46.000000 2350.0000 51.0870
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 12 13.000000 650.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 19.000000 950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 54.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1295 8855.500000 477609.0000 53.9336
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 32.000000 1728.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1073 9140.000000 63405.0000 6.9371
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 242 1428.000000 16992.0000 11.8992
OCCT-97530-OT SESSION BY LICENSED OT 150 1029.000000 83678.2800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 3 20.500000 1667.0600 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
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 281 2284.750000 183821.2500 80.4557
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 23.000000 1870.3600 81.3200
TRAV-TRAVS-Travel by mile 1485 156617.0000 69664.2900 0.4448
Subtotal (Total Children Is Unduplicated) 1593 182026.2500 1085810.8500 5.9651
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Total 183749.250000 1193816.7300 6.4970
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Number of Children (Unduplicated) With at Least One Service 1784
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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 26141 145114.000000 630403.6900 630403.6900
D 227 521.500000 8716.6400 0.0000
S 292 663.000000 10331.6400 0.0000
H 210 332.500000 19865.5000 0.0000
T 3205 13225.000000 84217.4300 84217.4300
9136 23682.250000 425437.9400 0.0000
Other 111 211.000000 14843.8900 0.0000
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Total 39322 183749.250000 1193816.7300 714621.1200