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
Payclass Filters:GR
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 215 346.250000 15748.1800 45.4821
Subtotal (Total Children Is Unduplicated) 232 358.000000 16284.9200 45.4886
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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 89 86.250000 4250.0000 49.2754
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.000000 925.5500 71.1962
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.500000 1115.4200 76.9255
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 242.9400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 809.8000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 27.500000 1647.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 19.500000 1168.4400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 520.6500 65.0813
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 134 201.250000 12139.4000 60.3200
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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 118 124.500000 6225.0000 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 131 225.750000 11287.5000 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 196 865.250000 46723.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 53.750000 2902.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 454 2925.000000 43875.0000 15.0000
INTR-T1013-INTERPRETER 155 324.750000 16132.9500 49.6781
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1156 7260.000000 87135.0000 12.0021
OCCT-97530-OT SESSION BY LICENSED OT 6 15.000000 1219.8000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 10 39.000000 3008.9800 77.1533
PHY-97110GP-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 72.000000 5573.4200 77.4086
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 8.000000 650.5600 81.3200
TRAV-TRAVS-Travel by mile 431 33473.00000 14707.9500 0.4394
Subtotal (Total Children Is Unduplicated) 1724 45773.75000 257699.3500 5.6299
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Total 46333.000000 286123.6700 6.1754
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Number of Children (Unduplicated) With at Least One Service 1863
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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 12085 38097.500000 210599.6500 210599.6500
D 264 383.750000 6068.2100 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 81.3200 0.0000
T 2605 7389.000000 46094.7500 46145.2000
605 461.750000 23279.7400 54.0000
Other 0 0.000000 0.0000 0.0000
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Total 15560 46333.000000 286123.6700 256798.8500