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
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) 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 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 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 19 35.500000 2127.1600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 569.2400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 647.8400 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 971.7600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 34.000000 2753.3200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.500000 769.3100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 181.500000 10875.4800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 65 132.500000 7939.4000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 42.000000 3401.1600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 60.500000 4899.2900 80.9800
Subtotal (Total Children Is Unduplicated) 242 561.000000 37250.6600 66.4005
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 12.000000 1227.2000 102.2667
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 45 42.000000 2100.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 102 104.500000 5225.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 36 40.750000 2037.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 21 23.250000 1162.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 11 10.250000 256.2500 25.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 2.000000 100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 13.000000 351.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 588 3506.000000 189320.0000 53.9989
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 167 335.000000 18090.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 459 2461.000000 36915.0000 15.0000
INTR-T1013-INTERPRETER 1 1.000000 33.5500 33.5500
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 354 1837.000000 22044.0000 12.0000
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 51 213.000000 17321.1600 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 2 2.000000 162.6400 81.3200
SENS-V5261-BEHIND EAR DIGITAL BINAURAL HEARING AID 1 1.000000 980.7400 980.7400
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 383.750000 31206.8800 81.3209
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 16.000000 1301.1200 81.3200
TRAV-TRAVS-Travel by mile 741 63503.00000 28246.1600 0.4448
Subtotal (Total Children Is Unduplicated) 807 72515.50000 358686.2000 4.9463
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Total 73076.500000 395936.8600 5.4181
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Number of Children (Unduplicated) With at Least One Service 871
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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 7 8.000000 570.5900 0.0000
H 0 0.000000 0.0000 0.0000
T 5352 37892.260000 109747.6200 109747.6200
7963 35176.240000 285618.6500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13322 73076.500000 395936.8600 109747.6200