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
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1306 6716.750000 248988.9000 37.0698
Subtotal (Total Children Is Unduplicated) 1306 6716.750000 248988.9000 37.0698
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 12 13.000000 278.9800 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 13.000000 209.9500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 13.000000 102.9600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 13.000000 413.5300 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 12 13.000000 300.8200 23.1400
EXIT-EXIT-COS Exit 138 143.750000 7151.0000 49.7461
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 23.000000 1814.7000 78.9000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 311.9600 77.9900
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.000000 985.4900 57.9700
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 58.500000 4444.3100 75.9711
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 911.9600 75.9967
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 833.9700 75.8155
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 48.500000 2780.4000 57.3278
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1723.3800 76.5947
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 219.0400 54.7600
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 303.4700 50.5783
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 17 18.000000 979.5300 54.4183
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 225.7400 56.4350
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 8 127.000000 7251.9300 57.1018
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 237 582.250000 32447.8500 55.7284
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 72.000000 19641.6300 272.8004
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 130 129.750000 6487.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 501 587.750000 29387.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 48 39.000000 975.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 167 284.000000 14200.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 420 1456.000000 72800.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 113.000000 5650.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 55 189.750000 9512.5000 50.1318
CONOP-CONOP-CONSULT, OT, PHONE 2 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 36.000000 1800.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 83 187.250000 9362.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 118.250000 5912.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 341 1247.500000 62375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 7 27.000000 1350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 600 13827.00000 727214.0000 52.5938
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 275 2754.500000 144134.0000 52.3267
EPIC-99601-Early Steps Professional Development Fee 729 16632.00000 249182.4200 14.9821
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1316 41432.00000 497197.4700 12.0003
OCCT-97530-OT SESSION BY LICENSED OT 84 872.750000 68033.8300 77.9534
OCCT-97530GO-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 14 117.000000 7220.1300 61.7105
PHY-97110-PT SESSION BY LICENSED PT 77 947.500000 73430.0200 77.4987
PHY-97110GT-PT SESSION BY LICENSED PT 2 5.000000 364.4800 72.8960
PHY-97110HM-PT SESSION BY PT ASST 8 66.000000 4105.1400 62.1991
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 1439.250000 110537.2100 76.8020
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 57.250000 4369.3500 76.3205
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 41.000000 2669.9200 65.1200
Subtotal (Total Children Is Unduplicated) 2018 82689.50000 2128356.0600 25.7391
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Total 89988.500000 2409792.8100 26.7789
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Number of Children (Unduplicated) With at Least One Service 2475
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Center 10
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 84849 82997.750000 2144866.8600 2144866.8600
D 14 13.000000 446.3200 0.0000
S 45 44.750000 695.5000 186.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8740 6931.500000 263728.3300 105.0000
Other 3 1.500000 55.8000 0.0000
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Total 93651 89988.500000 2409792.8100 2145158.3600