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
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 3 4.500000 167.4000 37.2000
Subtotal (Total Children Is Unduplicated) 3 4.500000 167.4000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 23 23.000000 493.5800 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 23 23.000000 371.4500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 22 23.000000 182.1600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 24.000000 731.6300 30.4846
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 21 22.000000 539.9900 24.5450
EXIT-EXIT-COS Exit 51 52.000000 2563.5000 49.2981
OCTH-97165-OT EVAL LOW COMPLEXITY 19 19.000000 1104.0900 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 9.000000 451.8400 50.2044
PSTH-97161-PT EVAL LOW COMPLEXITY 8 7.500000 435.8250 58.1100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 3.000000 116.2200 38.7400
SPCH-92521-EVAL OF SPEECH FLUENCY 32 33.000000 1859.5200 56.3491
SPCH-92521GT-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 348.6600 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 53 357.000000 20644.0500 57.8265
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 186 608.500000 30249.2850 49.7112
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 15.000000 42345.8600 2823.0573
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 35.250000 1762.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 179 154.250000 7712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 10.000000 250.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 36 42.750000 2137.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 168 317.500000 15875.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 24.000000 1200.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 24 53.000000 2650.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.750000 187.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 26 34.000000 1700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 30.000000 1500.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 139 248.750000 12437.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1298 11736.75000 633784.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 352 1421.500000 76747.5000 53.9905
EPIC-99601-Early Steps Professional Development Fee 537 4674.000000 69482.4200 14.8657
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1121 11327.00000 135924.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 247 1485.250000 118590.3900 79.8454
OCCT-97530GO-OT SESSION BY LICENSED OT 5 16.500000 1341.7800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 41 196.000000 12590.5100 64.2373
PHY-97110-PT SESSION BY LICENSED PT 333 1614.750000 127841.3000 79.1710
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 5 6.750000 548.9100 81.3200
PHY-97110HM-PT SESSION BY PT ASST 38 243.000000 15824.1600 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 2 2.000000 130.2400 65.1200
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 411 2289.250000 180942.0000 79.0399
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 38.250000 3110.4900 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 180.500000 11063.9000 61.2958
Subtotal (Total Children Is Unduplicated) 2010 36208.25000 1478245.3000 40.8262
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Total 36821.250000 1508661.9850 40.9726
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Number of Children (Unduplicated) With at Least One Service 2015
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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 25833 24388.000000 715703.6500 715688.6500
D 7 4.500000 280.4200 0.0000
S 60 58.500000 2111.2500 37.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
14246 12370.250000 790566.6650 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 40146 36821.250000 1508661.9850 715726.1500