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
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 633 409.000000 15214.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1671 9727.000000 361872.3000 37.2029
Subtotal (Total Children Is Unduplicated) 1747 10136.00000 377087.1000 37.2028
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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
EXIT-EXIT-COS Exit 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 13.000000 1052.7400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 17.500000 1417.1500 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 17.500000 1417.1500 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 31 52.500000 3145.8000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.500000 329.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 85 151.000000 12227.9800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 607.3500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 178 289.000000 23403.2200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 688.3300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 146 234.500000 18989.8100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 398 689.500000 41314.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 14.000000 838.8800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 22.000000 1781.5600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
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) 484 1582.500000 110624.8300 69.9051
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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 9 11.000000 550.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 3 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 177 179.000000 8950.0000 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 1394 13901.00000 750654.0000 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) 1450 32204.50001 1039589.0400 32.2809
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Total 43923.000013 1527300.9700 34.7722
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Number of Children (Unduplicated) With at Least One Service 2061
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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 221 252.500000 6961.9500 0.0000
S 0 0.000000 0.0000 0.0000
H 3224 5218.500000 236828.3100 236828.3100
T 14908 17389.043509 396525.7400 396525.7400
17688 21009.706504 885004.0700 505.0000
Other 56 53.250000 1980.9000 0.0000
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Total 36097 43923.000013 1527300.9700 633859.0500