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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
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 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
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 17 36.000000 2855.4800 79.3189
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 40 78.500000 4677.2000 59.5822
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 30 60.000000 3493.5400 58.2257
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 647.8400 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 7 13.500000 1093.2300 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 56.000000 4451.1600 79.4850
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1583.7200 79.1860
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 94.000000 7552.3200 80.3438
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 60 120.000000 9403.6500 78.3638
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 315 621.000000 36509.7500 58.7919
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 278 548.000000 32060.4500 58.5045
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 117.000000 9396.9200 80.3156
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 60 116.500000 9422.4600 80.8795
Subtotal (Total Children Is Unduplicated) 843 1973.500000 125907.7300 63.7992
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 58 114.000000 11237.9500 98.5785
AUDE-V5160-DISPENSING FEE BINAURAL 3 3.000000 694.8600 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 169 163.750000 8187.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 295 349.250000 17462.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 155 223.750000 11187.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 53 60.250000 3012.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 12 10.750000 268.7500 25.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 136.000000 3583.0000 26.3456
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 961 11814.50000 626801.0000 53.0535
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 447 1473.000000 78162.0000 53.0631
EPIC-99601-Early Steps Professional Development Fee 878 8653.000000 129795.0000 15.0000
INTR-T1013-INTERPRETER 8 21.750000 728.9600 33.5154
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 668 5783.000000 69396.0000 12.0000
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 82 670.000000 52808.9600 78.8193
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 13 15.000000 1173.0000 78.2000
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 90 1109.500000 88278.3200 79.5659
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 39 87.500000 6956.3800 79.5015
TRAV-TRAVS-Travel by mile 1270 197860.0000 88017.2500 0.4448
Subtotal (Total Children Is Unduplicated) 1388 228586.0000 1203051.8400 5.2630
-----------------------------------------------------------------------------------------------------------------------
Total 230559.500000 1328959.5700 5.7641
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1569
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 7 8.000000 570.5900 0.0000
H 0 0.000000 0.0000 0.0000
T 30008 187320.830000 602091.8200 601857.8500
15609 43230.670000 726297.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 45624 230559.500000 1328959.5700 601857.8500