CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2024 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 1659 1893.750000 70438.2000 37.1951
TCM-T1017TL-TARGETED CASE MANAGEMENT 3023 24603.00000 915761.7000 37.2215
Subtotal (Total Children Is Unduplicated) 3037 26496.75000 986199.9000 37.2197
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 6 6.000000 91.1400 15.1900
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 128.7600 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 96.9000 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 23.7600 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 8.000000 254.4800 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 75.9500 15.1900
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 3 3.000000 69.4200 23.1400
EXIT-EXIT-COS Exit 11 29.500000 1475.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 35.000000 2792.4400 79.7840
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 10.000000 776.9100 77.6910
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 44 75.000000 5995.7600 79.9435
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 13.500000 1060.3400 78.5437
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 30.500000 2439.9900 79.9997
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 82 144.000000 8546.8400 59.3531
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 25.000000 1460.4300 58.4172
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 381 645.500000 50986.8900 78.9882
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 34 56.000000 4391.3600 78.4171
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 519 860.500000 68436.4600 79.5310
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 48 74.500000 5835.6700 78.3311
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 283 469.500000 37425.1000 79.7127
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 40 58.500000 4590.8200 78.4756
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1121 1958.500002 115237.5700 58.8397
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 114 182.500000 10579.5900 57.9704
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 99.000000 7685.0000 77.6263
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 13.500000 1075.2900 79.6511
OCTF-97168-OT RE-EVAL EST PLAN CARE 49 58.000000 3209.5800 55.3376
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 335.2600 55.8767
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 109.5200 54.7600
OCTH-97167-OT EVAL HIGH COMPLEXITY 59 59.000000 3260.9900 55.2710
PSTF-97164-PT RE-EVAL EST PLAN CARE 19 24.000000 1327.6400 55.3183
PSTH-97161-PT EVAL LOW COMPLEXITY 11 11.000000 619.1100 56.2827
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 167.6300 55.8767
PSTH-97163-PT EVAL HIGH COMPLEXITY 24 24.000000 1314.2400 54.7600
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 12 12.000000 657.1200 54.7600
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 73 83.000000 4568.5300 55.0425
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 1492 5107.000002 347558.2200 68.0553
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 2757.7200 2757.7200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 19.000000 950.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 395 596.000000 29800.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 178 209.000000 10450.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 52.000000 2600.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 18 23.000000 1150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 754 1098.000000 54900.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 349 537.000000 26850.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 34 2195.000000 58359.0000 26.5872
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2369 56031.00000 2969588.0000 52.9990
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 106 556.000000 29548.0000 53.1439
EPIC-99601-Early Steps Professional Development Fee 1814 41294.00000 619362.0000 14.9988
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1052 15648.00000 187800.0000 12.0015
OCCT-97530-OT SESSION BY LICENSED OT 143 1497.634910 114888.0100 76.7130
OCCT-97530GO-OT SESSION BY LICENSED OT 2 6.000000 487.9200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 94 583.000006 36076.1600 61.8802
OCCT-97530TL-OT SESSION BY LICENSED OT 4 7.500000 539.7000 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 1 7.000000 433.2800 61.8971
PHY-97110-PT SESSION BY LICENSED PT 56 413.750000 31663.1100 76.5272
PHY-97110GPGT-PT SESSION BY LICENSED PT 5 7.000000 569.2400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 11 84.000000 6447.1200 76.7514
PHY-97110HM-PT SESSION BY PT ASST 70 773.750000 47328.3300 61.1675
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 131 832.500000 63306.1400 76.0434
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 30.500000 2396.0200 78.5580
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 91 496.500000 29632.0600 59.6819
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.500000 251.8600 71.9600
TRAV-TRAVS-Travel by mile 17 12666.00000 5636.1900 0.4450
Subtotal (Total Children Is Unduplicated) 2492 135669.6349 4333869.8600 31.9443
-----------------------------------------------------------------------------------------------------------------------
CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2024 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
Total 167273.384918 5667627.9800 33.8824
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3064
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 74.4000 0.0000
P 42 31.013969 2259.1500 2061.9300
D 829 860.500000 23858.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 12361 18491.500000 806903.9600 805407.5600
T 77063 89081.718775 2019009.5600 2019009.5600
59168 58751.152174 2813458.2700 978.6200
Other 58 55.500000 2064.6000 0.0000
---------------------------------------------------------
Total 149522 167273.384918 5667627.9800 2827457.6700