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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 446 376.500000 17177.3200 45.6237
TCM-T1017TL-TARGETED CASE MANAGEMENT 299 1033.750000 47213.2200 45.6718
Subtotal (Total Children Is Unduplicated) 617 1410.250000 64390.5400 45.6590
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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 3 3.500000 209.7200 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 8 8.500000 688.3300 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 2 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 15.000000 898.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 52 60.000000 3595.2000 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 5 5.000000 404.9000 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) 81 112.500000 7148.6800 63.5438
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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 9675.500000 256615.0400 26.5221
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Number of Children (Unduplicated) With at Least One Service 1327
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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
1339 1520.750000 71376.8900 0.0000
Other 1 1.000000 15.0000 15.0000
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Total 9532 9675.500000 256615.0400 183378.1500