CMS/EIP Fiscal Report Center: 10
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:GR
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 397 1251.500000 45672.3000 36.4940
Subtotal (Total Children Is Unduplicated) 397 1251.500000 45672.3000 36.4940
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 32.3000 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 15.8400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 63.6200 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 46.2800 23.1400
EXIT-EXIT-COS Exit 40 41.000000 2013.5000 49.1098
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 89.8800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 58.000000 3370.3800 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 55 130.000000 7074.4900 54.4192
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 593.3200 197.7733
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 24.500000 1225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 95 100.250000 5012.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 8.500000 212.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 27 34.750000 1737.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 125 244.500000 12225.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 22.000000 1100.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 18 45.000000 2250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 24 30.000000 1500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 22.000000 1100.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 106 193.750000 9687.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 218 2056.250000 111037.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 58 247.750000 13378.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 296 2788.000000 41504.4200 14.8868
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 597 7383.000000 88596.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 35 178.500000 14475.6200 81.0959
OCCT-97530HM-OT SESSION BY OT ASST 4 14.000000 911.6800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 29 139.250000 11177.1500 80.2668
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 4 15.000000 976.8000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 275.000000 20475.4200 74.4561
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 34.000000 2214.0800 65.1200
Subtotal (Total Children Is Unduplicated) 881 13862.50000 341581.1500 24.6407
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Total 15244.000000 394327.9400 25.8677
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Number of Children (Unduplicated) With at Least One Service 1004
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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 14247 13948.750000 347138.1500 347138.1500
D 1 1.000000 12.0000 0.0000
S 28 27.750000 364.5000 37.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1354 1265.000000 46757.4900 0.0000
Other 3 1.500000 55.8000 0.0000
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Total 15633 15244.000000 394327.9400 347175.6500