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
Agency Filter:EXT
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 45 33.250000 1236.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 174 382.250000 14219.7000 37.2000
Subtotal (Total Children Is Unduplicated) 180 415.500000 15456.6000 37.2000
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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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 440.5600 58.7413
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 647.8400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 84 159.000002 9352.6900 58.8219
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.500000 1033.1300 59.0360
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) 265 518.500002 28240.9800 54.4667
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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 26 40.000000 2000.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 11 12.000000 600.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 753 1097.000000 54850.0000 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 2367 56003.00000 2968076.0000 52.9985
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 105 551.000000 29278.0000 53.1361
EPIC-99601-Early Steps Professional Development Fee 1814 41292.00000 619332.0000 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) 2490 135610.6349 4330857.8600 31.9360
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Total 136544.634918 4374555.4400 32.0375
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Number of Children (Unduplicated) With at Least One Service 2517
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Center 57
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 42 31.013969 2259.1500 2061.9300
D 826 857.500000 23778.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 267 250.000000 11777.8200 11462.5200
T 77063 89081.718775 2019009.5600 2019009.5600
47380 46324.402174 2317730.8700 960.0200
Other 0 0.000000 0.0000 0.0000
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Total 125578 136544.634918 4374555.4400 2033494.0300