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
Payclass Filters:GR
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) 3 3.000000 48.4500 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 4.000000 31.6800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 4.000000 127.2400 31.8100
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 461.9600 76.9933
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 581.5200 58.1520
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 14.000000 1097.8400 78.4171
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 21.500000 1636.4200 76.1126
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 41.000000 2328.5400 56.7937
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 27.000000 1564.8000 57.9556
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 623.9200 77.9900
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 433.4300 78.8055
Subtotal (Total Children Is Unduplicated) 69 156.000000 9769.2400 62.6233
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 49 99.000000 8609.3800 86.9634
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 231.6200 231.6200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 109 126.500000 6325.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 234 290.000000 14500.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 115 170.250000 8512.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 37 41.250000 2062.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 7.000000 175.0000 25.0000
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 155 1422.750000 75102.5000 52.7869
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 73 260.750000 13805.5000 52.9454
EPIC-99601-Early Steps Professional Development Fee 528 6521.000000 97815.0000 15.0000
INTR-T1013-INTERPRETER 3 6.500000 205.5800 31.6277
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 412 4071.000000 48852.0000 12.0000
PHY-97110-PT SESSION BY LICENSED PT 18 155.000000 12080.4400 77.9383
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.000000 81.3200 81.3200
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
SENS-V5264-EARMOLD 2 8.000000 145.0400 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 73.000000 5805.3200 79.5249
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 785 139449.0000 62035.8800 0.4449
Subtotal (Total Children Is Unduplicated) 847 152713.0000 357806.6400 2.3430
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Total 152869.000000 367575.8800 2.4045
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Number of Children (Unduplicated) With at Least One Service 856
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Center 54
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 3 3.000000 124.6300 0.0000
H 0 0.000000 0.0000 0.0000
T 20995 137556.000000 328844.1600 328610.1900
2319 15310.000000 38607.0900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 23317 152869.000000 367575.8800 328610.1900