CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
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
EXIT-EXIT-COS Exit 15 14.500000 725.0000 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 1 2.000000 119.8400 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 3 6.000000 445.8800 74.3133
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 809.8000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.500000 2007.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 39.000000 3158.2200 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 32.2400 32.2400
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 60 129.000000 8786.5300 68.1126
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 4035.3000 4035.3000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 23.500000 1175.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 25 31.750000 1587.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 46 42.750000 2125.0000 49.7076
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 41 39.000000 1950.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 13.750000 687.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 12 11.250000 562.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 2.500000 125.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 3.250000 162.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 7.250000 362.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 32 31.500000 1575.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 122 573.000000 30942.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 22 69.000000 3726.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 200 1030.000000 15450.0000 15.0000
INTR-T1013-INTERPRETER 23 69.750000 3487.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 220 1145.000000 13740.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 101.000000 7869.7600 77.9184
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 0.750000 48.8400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 14 25.000000 1993.4100 79.7364
PHY-97110GT-PT SESSION BY LICENSED PT 3 15.000000 1219.8000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 3 2.000000 67.2600 33.6300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 82.750000 6140.5900 74.2065
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 406.6000 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 5.000000 325.6000 65.1200
TRAV-TRAVS-Travel by mile 96 4973.000000 2217.8400 0.4460
Subtotal (Total Children Is Unduplicated) 497 8310.250000 102333.1400 12.3141
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Total 8439.250000 111119.6700 13.1670
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Number of Children (Unduplicated) With at Least One Service 507
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Center 02
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3530 8386.250000 109614.3300 109501.1400
53 53.000000 1505.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3583 8439.250000 111119.6700 109501.1400