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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2108 1940.000000 72149.4000 37.1904
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 396 354.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3733 23520.25000 874873.2600 37.1966
Subtotal (Total Children Is Unduplicated) 3794 25815.00000 947022.6600 36.6850
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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 12 24.500000 1936.1700 79.0273
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 19 37.000000 2972.3400 80.3335
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 33 63.000000 4954.9800 78.6505
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 37 71.500000 5664.4900 79.2236
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 13.500000 1081.2700 80.0941
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 27 55.000000 4334.3000 78.8055
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 51 100.500000 5995.4400 59.6561
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 76 159.500000 9314.1400 58.3959
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 13 25.500000 2064.9900 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 11 21.000000 1700.5800 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 138 254.000000 20254.9700 79.7440
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 129 252.000000 19961.4500 79.2121
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 253 471.500000 37942.2500 80.4714
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 354 663.500000 53009.7700 79.8942
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 194.000000 15700.2800 80.9293
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 175 341.500000 26895.2100 78.7561
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 466 911.500000 53684.2100 58.8966
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 696 1374.500000 80733.8700 58.7369
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 303 597.500000 47386.8900 79.3086
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 185 362.500000 28912.8500 79.7596
SCREEN-T1023-SCREENING 8 9.000000 485.8200 53.9800
Subtotal (Total Children Is Unduplicated) 1578 6125.500000 429830.0900 70.1706
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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 623 813.500000 40687.5000 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 918 628.250000 31462.6400 50.0798
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 629 360.250000 18003.1600 49.9741
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1331 7500.000000 544.4300 0.0726
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 1658 14857.00000 223208.4300 15.0238
INTR-T1013-INTERPRETER 8 21.750000 728.9600 33.5154
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 992 8615.000000 103392.0000 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 39 72.500000 5673.9600 78.2615
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 12 16.000000 1170.0800 73.1300
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:Program Patients
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 79 726.500000 57209.3200 78.7465
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 1422 200538.0000 89208.6100 0.4448
Subtotal (Total Children Is Unduplicated) 2174 259466.5200 2109566.1500 8.1304
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Total 291407.020000 3486418.9000 11.9641
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Number of Children (Unduplicated) With at Least One Service 3807
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Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 30 26.000000 1231.9200 55.8000
U 0 0.000000 0.0000 0.0000
B 3677 3628.750000 177402.9400 108233.5900
P 17570 16600.600000 823982.5000 814179.3700
D 2325 2161.250000 120424.7200 553.3800
S 128 135.200000 4385.4700 0.0000
H 163 177.770000 14117.5800 181.4800
T 30481 189973.330000 625543.9400 624090.1700
58438 78414.920000 1704382.7800 74.4000
Other 340 289.200000 14947.0500 1901.7000
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Total 113152 291407.020000 3486418.9000 1549269.8900