CMS/EIP Fiscal Report              Center: 01 
Services beginning 10/01/2025 ending 12/31/2025                Date of Report:01/07/2026   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
 
Screening, Eval, and Assessment,Class #02
  ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL                      3               3.000000          145.5000           48.5000
  EXIT-EXIT-COS Exit                                      89              86.750000         4275.0000           49.2795
  IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT          1               2.000000          161.9600           80.9800
  IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF        1               2.000000          161.9600           80.9800
  IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT       2               4.000000          196.7300           49.1825
  IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT     9              17.000000         1237.8700           72.8159
  IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT         3               6.000000          485.8800           80.9800
  IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS      24              46.500000         2786.2800           59.9200
  IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS    20              39.000000         2336.8800           59.9200
  IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF     10              19.000000         1538.6200           80.9800
  IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF    7              13.000000         1006.5300           77.4254
  OCTH-97166GT-OT EVAL MODERATE COMPLEXITY                 1               1.000000           58.1100           58.1100
  OCTH-97167-OT EVAL HIGH COMPLEXITY                       1               1.000000           58.1100           58.1100
  PSTF-97164-PT RE-EVAL EST PLAN CARE                      1               1.000000           58.1100           58.1100
  PSTH-97162-PT EVAL MODERATE COMPLEXITY                   1               1.000000           58.1100           58.1100
  SPCH-92521-EVAL OF SPEECH FLUENCY                        2               2.000000          116.2200           58.1100
  SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP       1               1.000000           58.1100           58.1100
  SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION            1               3.000000          174.3300           58.1100
Subtotal (Total Children Is Unduplicated)                169             248.250000        14914.3100           60.0778
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EI Services,Class #03
  COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE            71              73.000000         3653.0000           50.0411
  COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE         115             121.000000         6050.0000           50.0000
  COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE                43              41.000000         1041.6600           25.4063
  CONIF-CONIF-CONSULT, ITDS FACE TO FACE                  34              40.500000         2031.0000           50.1481
  CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE              131             226.750000        11337.5000           50.0000
  CONIP-CONIP-CONSULT, ITDS PHONE                          8               7.250000          181.2500           25.0000
  CONOF-CONOF-CONSULT, OT, FACE TO FACE                    1               1.000000           50.0000           50.0000
  CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE                 17              31.000000         1550.0000           50.0000
  CONPF-CONPF-CONSULT, PT, FACE TO FACE                   10              10.500000          525.0000           50.0000
  CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE                 29              40.750000         2037.5000           50.0000
  CONSF-CONSF-CONSULT, SLP, FACE TO FACE                  21              23.500000         1175.0000           50.0000
  CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE                68              91.000000         4550.0000           50.0000
  CONSP-CONSP-CONSULT, SLP, PHONE                          1               1.000000           25.0000           25.0000
  EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF          558            3046.000000       163400.0000           53.6441
  EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF         71             180.250000         9733.5000           54.0000
  EPIC-99601-Early Steps Professional Development Fee    454            2925.000000        43875.0000           15.0000
  INTR-T1013-INTERPRETER                                 126             275.750000        13673.4500           49.5864
  NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE            1156            7260.000000        87135.0000           12.0021
  OCCT-97530-OT SESSION BY LICENSED OT                    11              60.000000         4879.2000           81.3200
  OCCT-97530GT-OT SESSION BY LICENSED OT                   1               1.000000           81.3200           81.3200
  PHY-97110-PT SESSION BY LICENSED PT                     48             303.750000        24213.4500           79.7151
  PHY-97110GP-PT SESSION BY LICENSED PT                    1               1.000000           81.3200           81.3200
  PHY-97110GT-PT SESSION BY LICENSED PT                    3               2.750000          223.6300           81.3200
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP           59             304.500000        23790.5420           78.1299
  SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP          5              22.000000         1789.0400           81.3200
  SPL-92507HM-SPL THERAPY SESSION BY SLP ASST              2               7.000000          455.8400           65.1200
  TRAV-TRAVS-Travel by mile                              419            33233.00000        14603.8500            0.4394
Subtotal (Total Children Is Unduplicated)               1692            48330.25000       422142.0520            8.7345
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Total                                                                  48578.500000       437056.3620            8.9969
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Number of Children (Unduplicated) With at Least One Service       1736
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Center 01
Flag      Claims          Units         Chgs         Paid
---------------------------------------------------------
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          14326   40145.500000  346426.9220  346426.9200 
D            474     604.250000   19223.2300       0.0000 
S              0       0.000000       0.0000       0.0000 
H              0       0.000000       0.0000       0.0000 
T           3038    7824.750000   71136.2500   70953.9600 
               3       4.000000     269.9600      54.0000 
Other          0       0.000000       0.0000       0.0000 
---------------------------------------------------------
Total      17841   48578.500000  437056.3620  417434.8800