CMS/EIP Fiscal Report Center: 10
Services beginning 07/01/2024 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 4 5.500000 204.6000 37.2000
Subtotal (Total Children Is Unduplicated) 4 5.500000 204.6000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 95 108.000000 2304.9100 21.3418
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 26.0400 26.0400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 95 107.000000 1695.7500 15.8481
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.2300 23.2300
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 100 112.000000 902.0800 8.0543
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 94 110.000000 3276.4300 29.7857
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 95 107.000000 2599.7900 24.2971
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 5.000000 181.2800 36.2560
AUDE-V5090-DISPENSING FEE PER HEARING AID 4 5.000000 579.0500 115.8100
EXIT-EXIT-COS Exit 152 157.750000 7851.0000 49.7686
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 35.9800 35.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 65 75.000000 4192.9400 55.9059
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 63 75.000000 3715.0200 49.5336
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 13.3500 13.3500
PSTH-97161-PT EVAL LOW COMPLEXITY 57 67.500000 3730.3150 55.2639
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 9.000000 348.6600 38.7400
SPCH-92521-EVAL OF SPEECH FLUENCY 160 179.750000 9889.8000 55.0197
SPCH-92521GT-EVAL OF SPEECH FLUENCY 4 4.000000 232.4400 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 22.000000 1160.0100 52.7277
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 88 946.000000 53438.3500 56.4887
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 581.1000 58.1100
Subtotal (Total Children Is Unduplicated) 576 2112.000000 97285.0650 46.0630
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 19 99.000000 75027.7500 757.8561
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 146 147.250000 7362.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 732 708.500000 35425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 55 43.500000 1087.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 183 305.250000 15262.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 471 1565.750000 78287.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 44 118.000000 5900.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 63 200.750000 10062.5000 50.1245
CONOP-CONOP-CONSULT, OT, PHONE 2 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 36.750000 1837.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 86 192.250000 9612.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 64 130.250000 6512.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 378 1333.500000 66675.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 31.500000 1575.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2221 48013.00000 2544431.0000 52.9946
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1052 9539.250000 504684.0000 52.9060
EPIC-99601-Early Steps Professional Development Fee 1019 19983.00000 299135.4200 14.9695
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1940 49312.00000 591757.4700 12.0003
OCCT-97530-OT SESSION BY LICENSED OT 548 8090.000000 621242.2700 76.7914
OCCT-97530GO-OT SESSION BY LICENSED OT 16 43.000000 3468.6800 80.6670
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 4.500000 333.1800 74.0400
OCCT-97530GT-OT SESSION BY LICENSED OT 10 28.500000 2200.6200 77.2147
OCCT-97530HM-OT SESSION BY OT ASST 115 1203.250000 72727.8200 60.4428
PHY-97110-PT SESSION BY LICENSED PT 653 9348.500000 716324.4100 76.6245
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 15 29.750000 2275.6500 76.4924
PHY-97110HM-PT SESSION BY PT ASST 62 808.000000 51247.1500 63.4247
PHY-97110HMGT-PT SESSION BY PT ASST 2 2.000000 130.2400 65.1200
SENS-V5050-IN EAR MONAURAL HEARING AID 4 4.000000 918.4400 229.6100
SENS-V5264-EARMOLD 5 8.000000 145.0400 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 866 12628.50000 972824.7800 77.0341
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 48 334.000000 25818.5000 77.3009
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 25 258.500000 15506.5800 59.9868
Subtotal (Total Children Is Unduplicated) 3559 164559.5000 6740064.6600 40.9582
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Total 166677.000000 6837554.3250 41.0228
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Number of Children (Unduplicated) With at Least One Service 3566
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Center 10
Flag Claims Units Chgs Paid
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R 2 4.000000 281.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 119272 110918.000000 3407791.5600 3407778.9100
D 45 41.750000 1725.9500 0.0000
S 100 89.000000 3382.3000 186.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
67444 55624.250000 3424372.7150 105.0000
Other 0 0.000000 0.0000 0.0000
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Total 186863 166677.000000 6837554.3250 3408070.4100