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: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 1336 2986.750000 111107.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1763 6407.250000 238405.5000 37.2087
Subtotal (Total Children Is Unduplicated) 1937 9394.000000 349512.6000 37.2059
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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 5 7.500000 607.3500 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 11.000000 890.7800 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 9 17.000000 1376.6600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 445.3900 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.000000 566.8600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 15.000000 898.8000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 32.500000 1947.4000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 90 151.000000 12227.9800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 147 265.500000 21500.1900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 91 168.000000 13553.6800 80.6767
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 225 416.500000 33686.0500 80.8789
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 103.000000 8340.9400 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 73.500000 5952.0300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 223 395.500000 23740.4800 60.0265
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 369 667.000000 40135.1200 60.1726
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) 907 3240.000000 213405.6000 65.8659
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 182 337.250000 16787.5000 49.7776
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 1327 8974.500000 484035.0000 53.9345
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 46.000000 2484.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1074 9148.000000 63525.0000 6.9441
INTR-T1013-INTERPRETER 99 451.750000 22437.5000 49.6680
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 1489 156854.0000 69769.7500 0.4448
Subtotal (Total Children Is Unduplicated) 1678 183162.0000 1129039.1000 6.1642
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Total 195796.000000 1691957.3000 8.6414
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Number of Children (Unduplicated) With at Least One Service 2311
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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 31723 151268.750000 875556.7500 875556.7500
D 235 590.500000 8805.5600 0.0000
S 300 678.500000 11544.7100 0.0000
H 2649 3447.500000 159065.0600 126948.7200
T 4200 14302.750000 129011.2000 129011.2000
10516 25237.000000 488829.4200 0.0000
Other 144 271.000000 19144.6000 0.0000
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Total 49767 195796.000000 1691957.3000 1131516.6700