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
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2 0.500000 22.8400 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 20 25.250000 1153.4200 45.6800
Subtotal (Total Children Is Unduplicated) 22 25.750000 1176.2600 45.6800
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Screening, Eval, and Assessment,Class #02
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) 3 3.000000 174.3300 58.1100
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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 8181.500000 186426.4100 22.7863
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Number of Children (Unduplicated) With at Least One Service 985
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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
33 26.750000 1188.2600 0.0000
Other 1 1.000000 15.0000 15.0000
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Total 8226 8181.500000 186426.4100 183378.1500