CMS/EIP Fiscal Report Center: 03
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 125 70.250000 3209.0200 45.6800
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 40.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 600 920.750000 42059.8600 45.6800
Subtotal (Total Children Is Unduplicated) 640 1031.000000 45268.8800 43.9077
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-COS Exit 5 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 479.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 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 7 19.000000 1538.6200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 27.500000 2226.9500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 65.000000 3894.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 30.000000 2429.4000 80.9800
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 12 12.000000 647.7600 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 96 201.500000 13898.0200 68.9728
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 38.250000 1937.5000 50.6536
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 11 10.250000 512.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 15.000000 750.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 7.000000 350.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 150 465.000000 25110.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 24.000000 1296.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 341 1106.000000 15662.0100 14.1609
INTR-T1013-INTERPRETER 8 22.000000 1762.5000 80.1136
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 174 549.000000 6588.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 31.000000 2357.3200 76.0426
PHY-97110-PT SESSION BY LICENSED PT 16 41.000000 3276.1100 79.9051
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 122.500000 9504.7500 77.5898
TRAV-TRAVS-Travel by mile 467 28463.00000 12663.3300 0.4449
Subtotal (Total Children Is Unduplicated) 533 30912.25000 82676.2700 2.6745
-----------------------------------------------------------------------------------------------------------------------
Total 32144.750000 141843.1700 4.4126
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 918
-----------------------------------------------------------------------------------------------------------------------
Center 03
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 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 0 0.000000 0.0000 0.0000
5747 32144.750000 141843.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5747 32144.750000 141843.1700 0.0000