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
Agency Filter:EXT
Payclass Filters:GR
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 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 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 19 37.000000 2996.2600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 50 112.000000 7635.8300 68.1771
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EI Services,Class #03
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 122 564.000000 30456.0000 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 9 15.500000 1260.4600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 6 13.500000 1097.8200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 14.000000 1138.4800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 32.000000 2602.2400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 96 4973.000000 2217.8400 0.4460
Subtotal (Total Children Is Unduplicated) 486 8140.750000 86001.6200 10.5643
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Total 8252.750000 93637.4500 11.3462
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Number of Children (Unduplicated) With at Least One Service 496
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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 3322 8205.750000 92546.4500 92433.2800
47 47.000000 1091.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3369 8252.750000 93637.4500 92433.2800