CMS/EIP Fiscal Report Center: 57
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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 2.250000 83.7000 37.2000
Subtotal (Total Children Is Unduplicated) 2 2.250000 83.7000 37.2000
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Screening, Eval, and Assessment,Class #02
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 2 2.000000 30.3800 15.1900
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 42.9200 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 32.3000 16.1500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 63.6200 31.8100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 30.3800 15.1900
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 1 2.000000 119.8400 59.9200
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 25 48.000000 2876.1600 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 12 12.000000 697.3200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 232.4400 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 174.3300 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 290.5500 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 406.7700 58.1100
Subtotal (Total Children Is Unduplicated) 62 102.500000 5882.5400 57.3906
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 4.750000 237.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 110 116.000000 5800.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 37 37.000000 1850.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 176 178.000000 8900.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 167 167.000000 8350.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 524.000000 14148.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1392 13886.00000 749844.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 41 139.000000 7506.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1092 10971.00000 164565.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 363 3100.000000 37224.0000 12.0077
OCCT-97530-OT SESSION BY LICENSED OT 27 211.500007 17199.1800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 12 54.000006 3516.4800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 14 50.000000 4066.0000 81.3200
PHY-97110GPGT-PT SESSION BY LICENSED PT 5 7.000000 569.2400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 4 9.500000 772.5400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 16 86.500000 5632.8800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 55.250000 4492.9300 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.500000 121.9800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 31.500000 2051.2800 65.1200
TRAV-TRAVS-Travel by mile 7 2544.000000 1132.0300 0.4450
Subtotal (Total Children Is Unduplicated) 1447 32185.50001 1038579.0400 32.2685
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Total 32290.250013 1044545.2800 32.3486
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Number of Children (Unduplicated) With at Least One Service 1471
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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 0 0.000000 0.0000 0.0000
D 220 251.500000 6911.9500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 14904 17382.043509 396085.2400 396085.2400
14741 14656.706504 641548.0900 505.0000
Other 0 0.000000 0.0000 0.0000
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Total 29865 32290.250013 1044545.2800 396590.2400