CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1942 1819.500000 67666.8000 37.1898
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 320 286.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3266 20265.75000 753889.5600 37.2002
Subtotal (Total Children Is Unduplicated) 3327 22371.50000 821556.3600 36.7233
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 6 7.000000 817.8100 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 4 4.000000 453.8500 113.4625
AACIS-92597TLGT-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 40 43.000000 2085.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 13 15.000000 242.2500 16.1500
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 20 24.000000 190.0800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 21 22.000000 699.8200 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 30.3800 15.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 46.2800 23.1400
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 81.2400 81.2400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 15.500000 1207.3500 77.8935
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 21.000000 1688.6200 80.4105
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 47.000000 3659.3000 77.8574
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 30 58.500000 4656.6000 79.6000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 473.9200 78.9867
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 20 42.000000 3329.4000 79.2714
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 43 84.500000 5036.7200 59.6062
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 48 101.500000 5918.3400 58.3088
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1417.1500 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 10 19.000000 1538.6200 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 106 197.000000 15677.9800 79.5837
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 90 177.500000 14057.0100 79.1944
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 174 325.500000 26051.0200 80.0339
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 268 504.000000 40344.6200 80.0488
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 69 125.500000 10192.0200 81.2113
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 111 219.000000 17217.3500 78.6180
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 358 693.500000 40752.0400 58.7629
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 469 932.000000 54672.1900 58.6611
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 216 426.000000 33726.0600 79.1692
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 131 257.500000 20517.7200 79.6805
SCREEN-T1023-SCREENING 8 9.000000 485.8200 53.9800
Subtotal (Total Children Is Unduplicated) 1137 4402.000000 307463.6700 69.8464
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 14 14.000000 654.5700 46.7550
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 191.7600 47.9400
AACFIT-92609TLGT-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 104 226.000000 24290.6300 107.4807
AUDE-V5160-DISPENSING FEE BINAURAL 3 3.000000 694.8600 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 284 309.750000 15514.5000 50.0872
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 622 812.500000 40637.5000 50.0154
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 180 245.500000 12262.5000 49.9491
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 589 378.500000 18937.5000 50.0330
CONIP-CONIP-CONSULT, ITDS PHONE 13 11.000000 275.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 166 201.250000 10118.8200 50.2799
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 917 627.750000 31437.6400 50.0799
CONOP-CONOP-CONSULT, OT, PHONE 5 4.250000 131.2500 30.8824
CONPF-CONPF-CONSULT, PT, FACE TO FACE 118 155.000000 7715.0000 49.7742
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 394 193.000000 9687.5000 50.1943
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 159 244.500000 12225.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 628 359.750000 17978.1600 49.9740
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1162 7352.500000 544.4300 0.0740
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 136.000000 3583.0000 26.3456
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 8 12.000000 600.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1152 13654.50000 724624.0000 53.0685
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 547 1891.000000 100138.0000 52.9551
EPIC-99601-Early Steps Professional Development Fee 1437 14559.00000 218723.4300 15.0232
INTR-T1013-INTERPRETER 8 21.750000 728.9600 33.5154
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 944 8547.000000 102576.0000 12.0014
OCCT-97530-OT SESSION BY LICENSED OT 124 1101.940000 76292.2400 69.2345
OCCT-97530GO-OT SESSION BY LICENSED OT 54 377.000000 30585.6200 81.1290
OCCT-97530GOGT-OT SESSION BY LICENSED OT 27 96.250000 7780.2500 80.8338
OCCT-97530GT-OT SESSION BY LICENSED OT 38 71.500000 5602.0000 78.3497
OCCT-97530HM-OT SESSION BY OT ASST 22 207.000000 14315.8400 69.1586
OCCT-97530HMGT-OT SESSION BY OT ASST 6 22.750000 1466.4400 64.4589
OCCT-97530TL-OT SESSION BY LICENSED OT 70 240.500000 17427.3300 72.4629
OCCT-97530TLGO-OT SESSION BY LICENSED OT 151 1382.740000 110345.9100 79.8024
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 45 102.750000 8168.4300 79.4981
OCCT-97530TLGT-OT SESSION BY LICENSED OT 11 14.000000 1026.1600 73.2971
OCCT-97530TLGTHM-OT SESSION BY OT ASST 18 33.000000 2148.9600 65.1200
CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530TLHM-OT SESSION BY OT ASST 26 225.500000 14684.5600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 131 1109.500000 87420.7800 78.7930
PHY-97110GP-PT SESSION BY LICENSED PT 3 3.000000 243.9600 81.3200
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 23 30.000000 2320.2600 77.3420
PHY-97110TL-PT SESSION BY LICENSED PT 78 725.500000 57137.3600 78.7558
PHY-97110TLGT-PT SESSION BY LICENSED PT 23 46.750000 3642.5900 77.9164
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 4 4.000000 3922.9600 980.7400
SENS-V5264-EARMOLD 6 17.000000 308.2100 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 201 1944.840000 160446.9200 82.4988
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 74 190.000000 15791.3300 83.1123
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 76 443.250000 35090.3700 79.1661
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 21 51.750000 3969.6300 76.7078
TRAV-TRAVS-Travel by mile 1270 197860.0000 88017.2500 0.4448
Subtotal (Total Children Is Unduplicated) 1904 256269.0200 2102685.9500 8.2050
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Total 283042.520000 3231705.9800 11.4177
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Number of Children (Unduplicated) With at Least One Service 3339
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Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 24.750000 1185.4200 55.8000
U 0 0.000000 0.0000 0.0000
B 3282 3146.500000 154832.0000 92856.0600
P 15907 14613.470000 733215.4600 723552.9800
D 2213 2037.330000 113213.6500 553.3800
S 123 128.200000 4355.4700 0.0000
H 155 165.270000 13105.3300 181.4800
T 30024 187336.830000 603392.9400 601939.1700
56096 75351.420000 1596199.6200 74.4000
Other 299 238.750000 12206.0900 1719.4500
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Total 108127 283042.520000 3231705.9800 1420932.7200