CMS/EIP Fiscal Report Center: 54
Services beginning 04/01/2025 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 651 446.000000 16581.9000 37.1791
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 91 73.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1632 5266.250000 196202.1000 37.2565
Subtotal (Total Children Is Unduplicated) 1683 5785.750000 212784.0000 36.7773
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 350.4900 116.8300
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 233.6600 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 8 8.000000 388.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 32.3000 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 31.6800 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 127.2400 31.8100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.000000 566.8600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 25.000000 1943.5200 77.7408
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 17.500000 1417.1500 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 21 39.500000 2366.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 17.500000 1048.6000 59.9200
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 5 10.000000 809.8000 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 61.500000 4980.2700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 35.500000 2874.7900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 58 108.500000 8883.8800 81.8791
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 58 103.500000 8381.4300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 42.000000 3579.6900 85.2307
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 39.000000 3158.2200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 110 207.500000 12373.4800 59.6312
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 104 210.000000 12583.2000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 123.000000 9960.5400 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 49 96.000000 7774.0800 80.9800
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 325 1194.000000 86079.1600 72.0931
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 3 3.000000 143.8200 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
AACFIT-92609TLGT-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 19 35.000000 7856.6800 224.4766
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 75 74.000000 3700.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 219 226.500000 11312.5000 49.9448
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 43 46.750000 2337.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 181 92.000000 4587.5000 49.8641
CONIP-CONIP-CONSULT, ITDS PHONE 12 10.500000 262.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 10 9.750000 487.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 308 172.750000 8693.8200 50.3260
CONOP-CONOP-CONSULT, OT, PHONE 4 4.000000 125.0000 31.2500
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 19.500000 975.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 137 59.500000 3000.0000 50.4202
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 25.250000 1262.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 195 91.500000 4562.5000 49.8634
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 550 1955.250000 121.4700 0.0621
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 13.000000 351.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 699 3977.750000 214790.5000 53.9980
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 200 391.000000 21114.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 784 4008.000000 60226.4700 15.0266
INTR-T1013-INTERPRETER 1 1.000000 33.5500 33.5500
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 488 2510.000000 30120.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 52 253.000000 21363.4000 84.4403
OCCT-97530GO-OT SESSION BY LICENSED OT 33 159.000000 13029.5600 81.9469
OCCT-97530GOGT-OT SESSION BY LICENSED OT 10 20.000000 1626.4000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 12 21.000000 1676.4000 79.8286
OCCT-97530HM-OT SESSION BY OT ASST 16 82.000000 6288.6400 76.6907
OCCT-97530HMGT-OT SESSION BY OT ASST 4 8.000000 520.9600 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 80 414.000000 33666.4800 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 12 41.000000 3334.1200 81.3200
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 10 14.000000 911.6800 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 18 80.500000 5242.1600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 82 307.500000 25005.9000 81.3200
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 4 3.250000 264.2900 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 42 170.500000 13865.0600 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 9 11.500000 935.1800 81.3200
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
CMS/EIP Fiscal Report Center: 54
Services beginning 04/01/2025 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
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 122 586.250000 48150.2200 82.1326
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 23 39.750000 3232.4700 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 45 122.750000 9982.0300 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 9.500000 772.5400 81.3200
TRAV-TRAVS-Travel by mile 741 63503.00000 28246.1600 0.4448
Subtotal (Total Children Is Unduplicated) 1190 79586.00000 595897.0800 7.4875
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Total 86565.750000 894760.2400 10.3362
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Number of Children (Unduplicated) With at Least One Service 1798
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Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.750000 1104.1000 55.8000
U 0 0.000000 0.0000 0.0000
B 2976 2851.250000 140560.3200 89880.0300
P 1892 1739.070000 90810.4400 89359.9800
D 421 330.480000 18868.3400 0.0000
S 21 19.450000 1269.9100 0.0000
H 116 127.250000 10058.1100 181.4800
T 5363 37903.260000 110642.1400 109828.9400
18200 43512.240000 518562.2000 74.4000
Other 85 59.000000 2884.6800 874.0700
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Total 29101 86565.750000 894760.2400 290254.7000