CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 4 2.500000 125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 209.7200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 7.500000 449.4000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 44.500000 3603.6100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 23 40.000000 3239.2000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 13.500000 1093.2300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 24.000000 1943.5200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 728.8200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 54.000000 3235.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 32 59.500000 3565.2400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 232.4400 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 174.3300 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 10.3600 10.3600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 23.000000 1064.8700 46.2987
Subtotal (Total Children Is Unduplicated) 103 307.500000 21059.2000 68.4852
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 14.000000 849.9500 60.7107
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 63 61.250000 3062.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 27 28.500000 1425.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 43 40.000000 2000.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 25 59.500000 2975.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 19.500000 975.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 22 54.000000 2700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 11.000000 550.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 5 2.500000 125.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 19.000000 950.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 9 8.500000 425.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 40.000000 1080.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 199 870.500000 47007.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 16.000000 864.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 422 2319.000000 34773.0000 14.9948
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 243 1014.000000 12029.3400 11.8633
OCCT-97530-OT SESSION BY LICENSED OT 23 102.000000 8178.4800 80.1812
OCCT-97530GO-OT SESSION BY LICENSED OT 2 13.000000 1057.1600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 30 112.500000 7722.1400 68.6412
PHY-97110GP-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 86.750000 6300.3200 72.6262
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 76.0200 38.0100
TRAV-TRAVS-Travel by mile 557 50476.00000 22469.2800 0.4451
Subtotal (Total Children Is Unduplicated) 662 55376.50000 158163.4300 2.8561
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Total 55684.000000 179222.6300 3.2186
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Number of Children (Unduplicated) With at Least One Service 677
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Center 05
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 7617 51822.000000 169320.6300 169320.6300
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
429 3862.000000 9902.0000 9902.0000
Other 0 0.000000 0.0000 0.0000
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Total 8046 55684.000000 179222.6300 179222.6300