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
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 3444 11453.75000 418409.0000 36.5303
Subtotal (Total Children Is Unduplicated) 3444 11453.75000 418409.0000 36.5303
-----------------------------------------------------------------------------------------------------------------------
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 38 72.500000 5871.0500 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.500000 445.3900 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 971.7600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 37 68.000000 4074.5600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.500000 850.2900 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 572 1060.500000 85879.2900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 33 61.000000 4939.7800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 116 208.000000 16801.7200 80.7775
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 25.500000 2064.9900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 130 242.500000 19597.1600 80.8130
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.000000 890.7800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 537 1007.000000 60339.4400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 15 28.500000 1707.7200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 140 225.000000 18341.9700 81.5199
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.500000 202.4500 80.9800
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) 954 3648.500000 253227.6350 69.4060
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 51310.500000 2149881.9350 41.8995
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3802
-----------------------------------------------------------------------------------------------------------------------
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 261 245.000000 9141.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 7858 7815.250000 355075.2500 0.0000
P 25834 24389.500000 715759.4500 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
20373 18514.750000 1056976.7650 0.0000
Other 372 283.000000 10536.9000 0.0000
---------------------------------------------------------
Total 54765 51310.500000 2149881.9350 715726.1500