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:TPIN
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 1.500000 75.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
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 28 48.500000 3927.5300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 27.500000 2146.9500 78.0709
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 15.000000 1214.7000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 15.000000 1214.7000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 7.500000 607.3500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 97.500000 5842.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 42.000000 2516.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 35.000000 2834.3000 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.500000 2145.9700 80.9800
OCTH-97166GT-OT EVAL MODERATE 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 1 1.000000 58.1100 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) 120 346.000000 24645.4200 71.2295
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 1.250000 62.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 392 2067.000000 110534.0000 53.4756
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 45 122.000000 6588.0000 54.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 58.000000 4716.5600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 44 265.750000 21285.7900 80.0970
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.750000 142.3100 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 233.500000 18298.4420 78.3659
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 14.000000 1138.4800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 7.000000 455.8400 65.1200
Subtotal (Total Children Is Unduplicated) 460 2773.250000 163403.2420 58.9212
-----------------------------------------------------------------------------------------------------------------------
Total 3119.250000 188048.6620 60.2865
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 540
-----------------------------------------------------------------------------------------------------------------------
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 2300 2352.250000 139680.5120 139680.5100
D 74 73.750000 4760.9300 0.0000
S 0 0.000000 0.0000 0.0000
H 134 224.250000 16518.0100 0.0000
T 441 448.500000 25695.3900 25466.1000
14 20.500000 1393.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2963 3119.250000 188048.6620 165146.6100