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
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 24 11.750000 536.7400 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 493 904.750000 41226.2000 45.5664
Subtotal (Total Children Is Unduplicated) 499 916.500000 41762.9400 45.5679
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EXIT-EXIT-COS Exit 91 87.750000 4325.0000 49.2877
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 647.8400 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 629.1600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 566.8600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 98 171.000000 13720.3900 80.2362
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 47 84.500000 6704.0200 79.3375
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 45.500000 3684.5900 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 36 66.000000 5344.6800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 51.000000 4129.9800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 27.500000 2226.9500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 138 235.500000 14111.1600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 58 103.500000 6201.7200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 63.500000 5142.2300 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 73.000000 5865.3300 80.3470
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) 453 1057.250000 74709.9500 70.6644
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 74 78.750000 3940.5000 50.0381
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 118 125.750000 6287.5000 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 9 8.500000 425.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 23 37.000000 1850.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 10.500000 525.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 31 42.750000 2137.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
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 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 563 3051.500000 163697.0000 53.6448
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 72 181.500000 9801.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 454 2925.000000 43875.0000 15.0000
INTR-T1013-INTERPRETER 155 325.750000 16182.9500 49.6790
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1156 7260.000000 87135.0000 12.0021
OCCT-97530-OT SESSION BY LICENSED OT 23 78.000000 6342.9600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 5 6.000000 487.9200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 57 312.750000 24945.3300 79.7612
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 66 311.500000 24359.7820 78.2015
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 431 33473.00000 14707.9500 0.4394
Subtotal (Total Children Is Unduplicated) 1751 48694.00000 429641.6320 8.8233
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Total 50667.750000 546114.5220 10.7783
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Number of Children (Unduplicated) With at Least One Service 2118
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Center 01
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 14385 40449.750000 350280.1620 350280.1600
D 480 613.250000 19722.8300 0.0000
S 344 258.500000 13589.9200 0.0000
H 853 1013.750000 65322.2600 48722.9300
T 3046 7837.500000 71790.1400 71611.3000
627 489.750000 25116.4400 54.0000
Other 7 5.250000 292.7700 0.0000
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Total 19742 50667.750000 546114.5220 470668.3900