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: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 698 470.500000 17493.3000 37.1802
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 108 90.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1790 6157.250000 229338.0000 37.2468
Subtotal (Total Children Is Unduplicated) 1842 6717.750000 246831.3000 36.7432
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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 5 10.000000 809.8000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 13.000000 1052.7400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 28.000000 2186.4600 78.0879
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 19.500000 1579.1100 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.000000 1052.7400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 24 45.500000 2726.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 30.500000 1827.5600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 809.8000 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 6 12.000000 971.7600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 76.000000 6154.4800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 30 57.000000 4615.8600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 87 161.000000 13135.3300 81.5859
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 77 137.000000 11094.2600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 72.000000 6009.0900 83.4596
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 27 50.500000 4089.4900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 264.500000 15788.9200 59.6935
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 152 302.000000 18095.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 187.500000 15183.7500 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 150.000000 12147.0000 80.9800
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 454 1670.000000 121087.5600 72.5075
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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 596 1993.750000 121.4700 0.0609
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 857 4098.000000 61576.4700 15.0260
INTR-T1013-INTERPRETER 1 1.000000 33.5500 33.5500
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 500 2527.000000 30324.0000 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:Program Patients
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 791 64429.00000 28658.1200 0.4448
Subtotal (Total Children Is Unduplicated) 1278 80657.50000 597863.0400 7.4124
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Total 89045.250000 965781.9000 10.8460
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Number of Children (Unduplicated) With at Least One Service 1958
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Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 29 25.000000 1150.6000 55.8000
U 0 0.000000 0.0000 0.0000
B 3343 3305.000000 161808.3800 105090.1600
P 2112 2016.320000 103600.0300 102140.7300
D 437 344.230000 19467.4000 0.0000
S 21 19.450000 1269.9100 0.0000
H 123 137.750000 10908.4000 181.4800
T 5447 38417.760000 114251.2800 113438.0800
18836 44705.990000 549671.9600 74.4000
Other 96 73.750000 3653.9400 874.0700
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Total 30444 89045.250000 965781.9000 321854.7200