CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:GR
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 419 352.750000 16092.4200 45.6199
TCM-T1017TL-TARGETED CASE MANAGEMENT 275 909.250000 41534.5400 45.6800
Subtotal (Total Children Is Unduplicated) 578 1262.000000 57626.9600 45.6632
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 89.8800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 5.500000 329.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 2.500000 202.4500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 7.500000 607.3500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 0.500000 40.4900 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 5.500000 329.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 40 47.000000 2816.2400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 80.9800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 4.000000 323.9200 80.9800
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 58 85.000000 5437.7000 63.9729
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 52.750000 2637.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 227 1592.000000 85968.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 13.000000 702.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 781 5383.000000 80745.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 198 1083.000000 12996.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 10.000000 563.2400 56.3240
PHY-97110-PT SESSION BY LICENSED PT 3 9.500000 772.5400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 325.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.500000 365.9400 81.3200
Subtotal (Total Children Is Unduplicated) 966 8152.750000 185075.8200 22.7010
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Total 9499.750000 248140.4800 26.1207
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Number of Children (Unduplicated) With at Least One Service 1283
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Center 04
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 8156 8117.750000 183405.1500 183363.1500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 36 36.000000 1818.0000 0.0000
T 0 0.000000 0.0000 0.0000
1216 1345.000000 62902.3300 0.0000
Other 1 1.000000 15.0000 15.0000
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Total 9409 9499.750000 248140.4800 183378.1500