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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 1.000000 45.6800 45.6800
Subtotal (Total Children Is Unduplicated) 1 1.000000 45.6800 45.6800
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 4.500000 364.4100 80.9800
Subtotal (Total Children Is Unduplicated) 4 8.500000 688.3300 80.9800
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 108.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 8.000000 486.9600 60.8700
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 267.2700 66.8175
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 50.500000 3649.7100 72.2715
Subtotal (Total Children Is Unduplicated) 21 65.500000 4526.9400 69.1136
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Total 75.000000 5260.9500 70.1460
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Number of Children (Unduplicated) With at Least One Service 26
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Center 03
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 0 0.000000 0.0000 0.0000
72 75.000000 5260.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 72 75.000000 5260.9500 0.0000